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CC BY 4.0 · Journal of Child Science 2019; 09(01): e93-e99
DOI: 10.1055/s-0039-1700526
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Underlying Characteristics and Outcome of Extensively Resistant Acinetobacter baumannii Infection and Colonization in a Saudi Neonatal Intensive Care Unit

Sarah Alsubaie 
1   Department of Pediatrics, Pediatric Infectious Diseases Unit, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Zahid Anwar
2   Neonatology Unit, Dallah Hospital, Riyadh, Saudi Arabia
3   Neonatal Services Section, Fatima Memorial Hospital and Medical College, Lahore, Pakistan
,
Mohamed Alhadidi
4   Infection Control Department, Dallah Hospital, Riyadh, Saudi Arabia
,
Boshra Alsaadi
5   Princess Nourah Bint Abdulrhman University, College of Medicine, Riyadh, Saudi Arabia
,
Muslim Alsaadi
2   Neonatology Unit, Dallah Hospital, Riyadh, Saudi Arabia
6   Department of Pediatrics, Pulmonology Unit, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
› Institutsangaben
Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Publikationsverlauf

04. April 2019

18. Juli 2019

Publikationsdatum:
31. Oktober 2019 (online)

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Abstract

Extensively drug-resistant Acinetobacter baumannii (XDRAB) is a rapidly emerging pathogen causing threat to health care settings. The resultant morbidity and mortality rates are high due to limited therapeutic options. The present study demonstrates the characteristics of neonates, infected or colonized with XDRAB, antibiotic susceptibility patterns of the isolates, and neonatal outcomes. This retrospective study was conducted in the neonatal intensive care unit (NICU) of Dallah hospital, Riyadh, Saudi Arabia during the period January 2015 to December 2017. All neonates with positive XDRAB cultures from any location in the body were included, infected and colonized cases were compared. XDRAB was isolated from 16 neonates. Seventy-five percent of the affected neonates were preterm, with a median gestational age and birth weight of 32.5 weeks and 1,675 g, respectively. The median time to XDRAB infection/colonization for all cases was 14 days. Seventy-five percent of the cases had central venous catheters and 50 percent had surgery/procedure performed during stay in NICU. Half of the affected neonates had underlying congenital anomalies and chronic medical conditions. Fourteen affected neonates (87%) received prior courses of cefotaxime. In 15 of 16 cases, XDRAB infection manifested clinically as late-onset sepsis with bacteremia and ventilator-associated pneumonia (VAP). XDRAB isolates were resistant to all β-lactams and carbapenems. Resistance rate to other antibiotics was 93% for gentamicin and 50% for ciprofloxacin. All XDRAB isolates were susceptible to colistin. Seventy-five percent of the infected neonates died due to XDRAB sepsis, while 37% of the colonized group died of other underlying diseases. Fifty percent of the infected neonates died within 4 days of XDRAB infection. Prematurity, low birth weight, the use of vascular devices, and prior use of cefotaxime played a major role in XDRAB infection/colonization in our unit. It is crucial to consider early start of colistin, either alone or in combination therapy, especially for the neonates at high risk, for example, those with certain underlying chronic conditions who manifest with late-onset sepsis and/or VAP.

Keywords

Acinetobacter baumannii - neonate - neonatal intensive care units - extensively drug resistance

Author contributions

S.A., Z.A., and M.A. designed the study. S.A. and Z.A. contributed to the clinical diagnosis and management of the patients. S.A. revised the data, wrote the first draft, and prepared [Table 1]. Z.A. collected the data and prepared [Table 2], and revised the manuscript. M.N.A. collected the data. B.A. and M.A. revised and edited the final version.