The Changes in Epidemiology of Imipenem-Resistant Acinetobacter baumannii Bacteremia in a Pediatric Intensive Care Unit for 17 Years

Abstract

Background Acinetobacter baumannii infections cause high morbidity and mortality in intensive care unit (ICU) patients. However, there are limited data on the changes of long-term epidemiology of imipenem resistance in A. baumannii bacteremia among pediatric ICU (PICU) patients. Methods A retrospective review was performed on patients with A. baumannii bacteremia in PICU of a tertiary teaching hospital from 2000 to 2016. Antimicrobial susceptibility tests, multilocus sequence typing (MLST), and polymerase chain reaction for antimicrobial resistance genes were performed for available isolates. Results A. baumannii bacteremia occurred in 27 patients; imipenem-sensitive A. baumannii (ISAB, n = 10, 37%) and imipenem-resistant A. baumannii (IRAB, n = 17, 63%). There was a clear shift in the antibiogram of A. baumannii during the study period. From 2000 to 2003, all isolates were ISAB (n = 6). From 2005 to 2008, both IRAB (n = 5) and ISAB (n = 4) were isolated. However, from 2009, all isolates were IRAB (n = 12). Ten isolates were available for additional test and confirmed as IRAB. MLST analysis showed that among 10 isolates, sequence type 138 was predominant (n = 7). All 10 isolates were positive for OXA-23-like and OXA-51-like carbapenemase. Of 27 bacteremia patients, 11 were male (41%), the median age at bacteremia onset was 5.2 years (range, 0–18.6 years). In 33% (9/27) of patients, A. baumannii was isolated from tracheal aspirate prior to development of bacteremia (median, 8 days; range, 5–124 days). The overall case-fatality rate was 63% (17/27) within 28 days. There was no statistical difference in the case fatality rate between ISAB and IRAB groups (50% vs. 71%; P = 0.422). Conclusion IRAB bacteremia causes serious threat in patients in PICU. Proactive infection control measures and antimicrobial stewardship are crucial for managing IRAB infection in PICU.

Epidemiological Characteristics and Antimicrobial Resistance Changes of Carbapenem-Resistant Klebsiella pneumoniae and Acinetobacter baumannii under the COVID-19 Outbreak: An Interrupted Time Series Analysis in a Large Teaching Hospital

“…Children with low body weight and incomplete immune systems are more susceptible to the invasion of external pathogens and nosocomial infection [ 13 ]. Additionally, limited types of antibiotics are available for children, so cephalosporins, carbapenems, and macrocyclic lipids are widely used, which may lead to drug resistance [ 14 ] The resistance rates of CRKP and CRAB were also found to be higher in the ICU compared with other departments, which is in line with previous research findings [ 2 , 15 , 16 , 17 ]. In developed countries, over 20% of nosocomial infections occur in the ICU [ 18 ], where patients are at a higher risk of MDRO infection due to low organ function; comprised immunity; and underlying diseases such as diabetes, chronic obstructive pulmonary disease, and chemotherapy [ 4 ].…”

Correlative factor of death in patients with infected pancreatic necrosis after surgical intervention

“…[18] A baumannii infection could result in death in an intensive unit. [19][20][21][22][23] Finally, it was found that the patients who suffered from death got higher rates of usage of continuous renal replacement therapy and mechanical ventilation. Patients who needed the treatment of continuous renal replacement therapy or mechanical ventilation usually suffered from severe forms of AP.…”

“…Because of the abuse of antibiotics, A baumannii was resistant to multiple antibiotics, named “Multiple Resistance Acinetobacter Baumannii .” [18] A baumannii infection could result in death in an intensive unit. [19–23]…”

Rapid Direct Identification of Microbial Pathogens and Antimicrobial Resistance Genes in Positive Blood Cultures Using a Fully Automated Multiplex PCR Assay

“… 9 The rapid detection of bacterial infections in BCs and subsequent antimicrobial susceptibility testing (AST) are essential for effective antimicrobial stewardship programs and patient care. 10 11 12 13 Molecular techniques that use direct blood samples or positive BCs can expedite bacterial identification and predict antimicrobial susceptibility. 14 The BioFire Blood Culture Identification (BCID; bioMérieux, Marcy-l’Etoile, France) Panel is a multiplex, single pouch polymerase chain reaction (PCR) kit that identifies 24 pathogens and detects three resistance genes ( mecA , vanA / B , and KPC).…”