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

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
› Author Affiliations
Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Further Information

Publication History

04 April 2019

18 July 2019

Publication Date:
31 October 2019 (online)

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.

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.


 
  • References

  • 1 Papp-Wallace KM, Endimiani A, Taracila MA, Bonomo RA. Carbapenems: past, present, and future. Antimicrob Agents Chemother 2011; 55 (11) 4943-4960
  • 2 Tsiatsiou O, Iosifidis e, Katragkou A. , et al. Successful management of an outbreak due to carbapenem-resistant Acinetobacter baumannii in a neonatal intensive care unit. Eur J Pediatr 2015; 174 (01) 65-74
  • 3 Saleem AF, Ahmed I, Mir F, Ali SR, Zaidi AK. Pan-resistant Acinetobacter infection in neonates in Karachi, Pakistan. J Infect Dev Ctries 2009; 4 (01) 30-37
  • 4 Al Jarousha AM, El Jadba AH, Al Afifi AS, El Qouqa IA. Nosocomial multidrug-resistant Acinetobacter baumannii in the neonatal intensive care unit in Gaza City, Palestine. Int J Infect Dis 2009; 13 (05) 623-628
  • 5 Baş AY, Demirel N, Zenciroglu A, Göl N, Tanir G. Nosocomial blood stream infections in a neonatal intensive care unit in Ankara, Turkey. Turk J Pediatr 2010; 52 (05) 464-470
  • 6 Nakwan N, Chokephaibulkit K. Carbapenem-resistant Acinetobacter baumannii bacteremia in neonates. Pediatr Infect Dis J 2013; 32 (02) 197
  • 7 Roy S, Basu S, Dasgupta S, Singh AK, Viswanathan R. Carbapenem resistance in Acinetobacter baumannii isolated from blood of neonates with sepsis. Indian J Med Microbiol 2010; 28 (04) 416-417
  • 8 Cockerill FR, Patel JB, Alder J. , et al. Performance Standards for Antimicrobial Susceptibility Testing. Twenty-Third Informational Supplement M100–S23. Wayne, PA: CLSI; 2013
  • 9 Magiorakos AP, Srinivasan A, Carey RB. , et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18 (03) 268-281
  • 10 Cernada M, Brugada M, Golombek S, Vento M. Ventilator-associated pneumonia in neonatal patients: an update. Neonatology 2014; 105 (02) 98-107
  • 11 Litzow JM, Gill CJ, Mantaring JB. , et al. High frequency of multidrug-resistant gram-negative rods in 2 neonatal intensive care units in the Philippines. Infect Control Hosp Epidemiol 2009; 30 (06) 543-549
  • 12 Zaidi AK, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet 2005; 365 (9465): 1175-1188
  • 13 Nakwan N, Wannaro J, Nakwan N, Patungkalo W, Chokephaibulkit K. Clinical features, risk factors, and outcome of carbapenem-resistant Acinetobacter baumannii bacteremia in a Thai neonatal intensive care unit. Asian Biomed 2012; 6: 473-479
  • 14 McGrath EJ, Chopra T, Abdel-Haq N. , et al. An outbreak of carbapenem-resistant Acinetobacter baumannii infection in a neonatal intensive care unit: investigation and control. Infect Control Hosp Epidemiol 2011; 32 (01) 34-41
  • 15 von Dolinger de Brito D, Oliveira EJ, Abdallah VO, da Costa Darini AL, Filho PP. An outbreak of Acinetobacter baumannii septicemia in a neonatal intensive care unit of a university hospital in Brazil. Braz J Infect Dis 2005; 9 (04) 301-309
  • 16 Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008; 46 (08) 1254-1263
  • 17 Ayan M, Durmaz R, Aktas E, Durmaz B. Bacteriological, clinical and epidemiological characteristics of hospital-acquired Acinetobacter baumannii infection in a teaching hospital. J Hosp Infect 2003; 54 (01) 39-45
  • 18 Sheng WH, Liao CH, Lauderdale TL. , et al. A multicenter study of risk factors and outcome of hospitalized patients with infections due to carbapenem-resistant Acinetobacter baumannii . Int J Infect Dis 2010; 14 (09) e764-e769
  • 19 Thatrimontrichai A, Apisarnthanarak A, Chanvitan P, Janjindamai W, Dissaneevate S, Maneenil G. Risk factors and outcomes of carbapenem-resistant Acinetobacter baumannii bacteremia in neonatal intensive care unit: a case-case-control study. Pediatr Infect Dis J 2013; 32 (02) 140-145
  • 20 Lee HY, Hsu SY, Hsu JF, Chen CL, Wang YH, Chiu CH. Risk factors and molecular epidemiology of Acinetobacter baumannii bacteremia in neonates. J Microbiol Immunol Infect 2018; 51 (03) 367-376
  • 21 Zarrilli R, Bagattini M, Esposito EP, Triassi M. Acinetobacter infections in neonates. Curr Infect Dis Rep 2018; 20 (12) 48-52
  • 22 Maciel WG, da Silva KE, Croda J. , et al. Clonal spread of carbapenem-resistant Acinetobacter baumannii in a neonatal intensive care unit. J Hosp Infect 2018; 98 (03) 300-304
  • 23 Jajoo M, Kumar V, Jain M, Kumari S, Manchanda V. Intravenous colistin administration in neonates. Pediatr Infect Dis J 2011; 30 (03) 218-221
  • 24 Apisarnthanarak A, Holzmann-Pazgal G, Hamvas A, Olsen MA, Fraser VJ. Antimicrobial use and the influence of inadequate empiric antimicrobial therapy on the outcomes of nosocomial bloodstream infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2004; 25 (09) 735-741