Effects of Carbapenem consumption on the prevalence of Acinetobacter infection in intensive care unit patients (original) (raw)
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Bangladesh Journal of Medical Science
Objective: Acinetobacter spp. infection is a challenging problem in intensive care unit (ICU) because of its multi-drug resistant (MDR) in nature to antibiotic therapy including broadspectrum carbapenem group. The aims of the study were to determine the risk factors of mortality and the outcome of carbapenem-resistant Acinetobacter spp. (CRAs) infection in our ICU. Materials and Method: This is a retrospective, cross-sectional study, done in 2 years from January 2008 to December 2009. The list of the patients was obtained from hospital nosocomial infection surveillance unit and ICU infection record. The data of the patients were subsequently reviewed from their respective medical records after approval from university ethics committee and hospital medical record unit. Results and Discussion: A total of 92 patients were reviewed and only 54 were included and analyzed. The prevalence of CRAs over 24 months was 7.3%. Mortality was 50% among the reviewed patients and this contributed 13...
Indian Journal of Microbiology Research, 2023
Background: Acinetobacter baumannii was considered as a leading cause of nosocomial respiratory infection and bacteremia in many hospitals all over the world. However, there was a still a debates whether colonization and/or infection with Acinetobacter baumannii, increases morbidity and mortality independently of the effect of other risk factors.. Aim of the study was to isolate Acinetobacter baumannii among ICU patients, to detect carbapenem resistant Acinetobacter baumannii among ICU patients with Acinetobacter baumannii infections and to determine specific risk factors and outcome of the infections due to CRAB isolates. Materials and Methods: A retrospective study was carried out at Vydehi Institute of Medical Sciences and RC in Bangalore, in the ICU department from June 2021 to May 2022. Results: Among all the patients carbapenem resistance was detected more in patients above 60 years of age, males were predominant than females, most of the patients were on ventilation and in sepsis and mortality rate was high with the increased duration of ICU stays. Conclusion: Acinetobacter baumannii is a highly prevalent microorganism among ICU patients, while its potential to acquire resistance toward commonly used antibiotics represents it as a grave threat to the health care industry. Therefore, signifying the need for its regular monitoring in the health care setups. VAP due to CRAB and excess use of intravascular devices are the most important risk factors for CRAB bacteremia in our ICU. Early implementation of appropriate antimicrobial therapy, particularly in critically ill ICU patients with Carbapenem resistant Acinetobacter baumannii infections, with two or more co morbidities, can be crucial for survival. Keywords: Carbapenem resistance, Acinetobacter baumannii, Multi drug resistance, Intensive care unit, Cardiac care unit, Cardiothorasic surgery unit, CRAB, VAP.
Infection, 2010
Background There has been an increasing incidence of carbapenem-resistant Acinetobacter baumannii (CRAB) infections in recent years. The objective of this study was to determine specific risk factors for and outcome of bacteremia due to CRAB isolates among our ICU patients with A. baumannii bacteremia. Patients and methods Among 96 patients with ICUacquired A. baumannii bacteremia, 30 patients with CRAB were compared with the remaining 66 with carbapenemsusceptible A. baumannii (CSAB) isolates. Results Recent ventilator-associated pneumonia (VAP) due to CRAB (OR 16.74, 95% CI 3.16-88.79, p = 0.001) and a greater number of intravascular devices (OR 3.93, 95% CI 1.9-13.0, p = 0.025) were independently associated with CRAB bacteremia acquisition. Patients with CRAB bacteremia had a lower severity of illness on admission than those with CSAB. Although, by univariate analysis, patients with CRAB were more likely to have had exposure to colistin, carbapenems and linezolid, multivariate analysis did not revealed any significant association. The mortality was not different between patients with CRAB and CSAB bacteremia (43.3 vs. 46.9%, p = 0.740).
Erciyes Medical Journal, 2019
This study aims to investigate the effect of carbapenem restriction on the infection rate and antibiotic susceptibility. We divided the study period into two: carbapenem-free period (CFP) and carbapenem-restricted period (CRP). We compared the usage rate of antipseudomonal carbapenem, the incidence of nosocomial infection, invasive device days, the causative microorganisms, and antibiotic susceptibility. The nosocomial infection density was 40.95±19.02 in 1000 patient days in the CFP, and 20.71±4.28 in 1000 patient days in the CRP. We observed no significant difference between the two periods in terms of invasive devices use rates. Anti pseudomonal carbapenem usage rate was 2.73 in CFP and 1.67 in CRP. Of the 40 nosocomial infections due to Acinetobacter baumannii, 27 of them were found in the CFP. Carbapenem restriction policy may contribute to decrease the rate of resistant bacterial infections.
Objective: Multi-drug resistant Acinetobacter baumannii isolation is increasing among hospital infections. This study aims to examine the factors affecting the morbidity and mortality together with the selections and periods of the treatment applied on multi-drug resistant and extreme drug resistant A. baumannii infections that develop in intensive care unit patients. Materials and Methods: Of the 20 cases involved in the study (10 male, 10 female; mean age 71,9 ?16 years), laboratory and treatment results as well were assessed during the treatment. Antibiotic susceptibility test was practiced with disk diffusion test in A. baumannii strains and it was practiced by using E test for colistin, meropenem, and imipenem. Results: The infections detected as ventilator associated pneumonia (VAP) were determined on the 14th day of hospitalization on the average, and the follow up period is 40,8 days in the intensive care unit (ICU). The values of Acute Physiology and Chronic Health Evaluation II (APACHE II) was 26,8 ?3,2. The most preferred combinations are colistin-sulbactam and colistin-carbapenem. In three of the cases, the isolates were resistant to all antibiotics. During colistin treatment, dermatitis was observed in two subjects and nephrotoxicity in five subjects. Thirteen of the subjects were lost because of not eradicating the active microorganism resistant to antibiotics. Conclusion: In our study it was concluded that early diagnosis and treatment and needed isolation precautions are important in infection follow-up in the infections caused by A. baumannii strains that have an important role in intensive care infections.
Antimicrobial Agents and Chemotherapy, 2011
Nosocomial Acinetobacter baumannii bloodstream infections occur with significant prevalence and mortality. The relationship between carbapenem resistance in A. baumannii and patient outcomes remains unclear. A retrospective cohort study was conducted on patients with A. baumannii bacteremia. Outcomes, controlling for confounders, were compared for carbapenem-nonresistant A. baumannii (CNRAB) and carbapenem-resistant A. baumannii (CRAB). The primary outcome studied was all-cause hospital mortality, and the secondary endpoints evaluated were time to mortality, time to negative cultures, and length of stay postinfection for survivors. A total of 79 patients, 37 infected with CRAB and 42 with CNRAB, were studied. Hospital mortality was greater in the CRAB group as determined based on bivariate analysis (P < 0.01); however, this effect was nullified when controlling for relevant confounders with logistic regression and a Cox proportional-hazards model (P ؍ 0.71 and 0.75, respectively). Values for time to mortality and time to negative cultures did not differ between the groups. The median number of days of stay postinfection for survivors was greater for the CRAB group than the CNRAB group (14 versus 6.5; P < 0.01). Patients who received active antimicrobial therapy were less likely to die (93.5% versus 74.2%; P ؍ 0.02), regardless of carbapenem susceptibility classifications, and this result was robust in the multivariate model (P ؍ 0.02). Trends existed for improved outcomes in patients receiving an active beta-lactam, and patients fared worse if they had received a polymyxin as an active agent. Patients with CRAB bloodstream infections were more chronically ill and had more comorbidities. Inactive therapy was more important than carbapenem susceptibility with respect to outcomes, was a strong predictor of death, and is potentially modifiable.
Carbapenem Resistant Acinetobacter-A Major Pathogen in a Tertiary Care Hospital
Pakistan Armed Forces Medical Journal, 2015
Objective: To determine the frequency of carbapenem resistant Acinetobacter in the Military Hospital Rawalpindi, Pakistan. Study Design: Descriptive study. Place and Duration of Study: Department of Microbiology, Army Medical College, from Oct, 2012 to Feb, 2013. Material and Methods: Clinical specimens like naso-bronchial lavage, blood, pus, sputum and catheter tips were inoculated on blood agar and Mac Conkey agar while the urine samples were inoculated on Cystine Lactose Electrolyte Deficient (CLED) agar. Acinetobacter spp. isolated, were later subjected to antimicrobial susceptibility testing using the modified Kirby-Bauer disc diffusion method on Mueller Hinton agar as per Clinical Laboratory and Standards Institute (CLSI) guidelines. Results: Out of a total of 85 Acinetobacter spp. 62 isolates were found to be carbapenem resistant. They were also found to be 100% resistant to ciprofloxacin and ceftriaxone thus becoming multidrug resistant followed by tazobactam piperacillin (9...
Journal of Medical Microbiology, 2017
Purpose. Acinetobacter baumannii and Pseudomonas aeruginosa provoke serious infections, especially in intensive care unit (ICU) patients. Methodology. The risk factors and predictors of mortality for P. aeruginosa (n=84; 46 carbapenem-resistant) and A. baumannii (n=129; all carbapenem-resistant) bloodstream infections (BSIs) in an ICU were evaluated. Antibiotic susceptibility testing was performed using the agar disk diffusion method according to EUCAST guidelines. The minimum inhibitory concentration was determined by a gradient method (Etest). Multilocus sequence typing (MLST) was performed for P. aeruginosa during the carbapenem-resistant outbreak in 2014. Epidemiological data were collected from the patients' chart reviews. Results/Key findings. Hospitalization during the summer months, prior KPC-producing Klebsiella pneumoniae (KPC-Kp) BSI, and the administration of tigecycline, aminoglycosides and cortisone were independently associated with P. aeruginosa BSIs. MLST revealed the dissemination of clone ST227, including carbapenem-resistant P. aeruginosa strains. Hospitalization during the summer months, prior KPC-Kp BSI, and the administration of antibiotics, carbapenem and cortisone were independently associated with A. baumannii BSIs. The 30-day mortality rate for P. aeruginosa and A. baumannii BSI was 45.2 and 39.5 %, respectively. Sequential organ failure assessment (SOFA) score at onset, septic shock, age, and prior KPC-Kp BSI were significantly associated with P. aeruginosa BSI mortality. The administration of at least one active antibiotic was identified as a predictor of a good prognosis. Septic shock and simplified acute physiology score (SAPS) II at onset were independently associated with A. baumannii BSI mortality. The administration of at least one active antibiotic and colistinvancomycin co-administration were identified as predictors of a good prognosis. Conclusion. KPC-Kp infection predisposes ICU patients to BSI by either A. baumannii or P. aeruginosa. The administration of at least one active antibiotic leads to better survival rates.