Risk Factors for Extensively Drug-Resistant Acinetobacter baumannii in Neonatal Patients
Introduction Extensively drug-resistant Acinetobacter baumannii infections (XDRABIs) are significant causes of mortality and morbidity in neonatal patients due to the treatment difficulties and limitations. In the present study, we aimed to evaluate the characteristics and risk factors for XDRABIs acquisition during hospitalization.
Methods We investigated the risk factors of health care-associated infections (HC-AIs) caused by multidrug-resistant A. baumannii in the four neonatal units between January 2008 and December 2018. The patients and the control group's data and culture results were recorded and analyzed on a daily basis.
Results A total of 70 patients infected with XDRABIs and 118 control patients were included in the study. Univariate analysis showed that prematurity, gestation age, birth weight, mechanical ventilation, parenteral nutrition, transfusion, use of glycopeptides, and aminoglycosides were significantly associated with XDRABIs. In the univariate analysis, gestation age, mechanical ventilation, transfusion, parenteral nutrition, use of glycopeptides, carbapenems, and aminoglycosides were significantly associated with mortality. In the multiple logistic regression analysis, gestation age (p = 0.034), transfusion (p < 0.001), and use of glycopeptides (p = 0.019) were determined to be independent predictors of mortality in newborn infants with XDRABIs (R-square = 0.546).
Conclusion Determination of the risk factors, avoiding invasive procedures, rational use of antibiotics will lead to a decrease in the mortality and morbidity rates related to XDRABIs.
This work has been presented as a poster in the 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID); April 22 to 25, 2017, Vienna, Austria.
Received: 12 June 2020
Accepted: 20 October 2020
16 December 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Tekin R, Dal T, Pirinccioglu H, Oygucu SE. A 4-year surveillance of device-associated nosocomial infections in a neonatal intensive care unit. Pediatr Neonatol 2013; 54 (05) 303-308
- 2 Chan M-C, Chiu S-K, Hsueh P-R, Wang NC, Wang CC, Fang CT. Risk factors for healthcare-associated extensively drug-resistant Acinetobacter baumannii infections: a case-control study. PLoS One 2014; 9 (01) e85973
- 3 Ertugrul S, Aktar F, Yolbas I. et al. Risk factors for health care-associated bloodstream infections in a neonatal intensive care unit. Iran J Pediatr 2016; 26 (05) e5213
- 4 Kumar A, Randhawa VS, Nirupam N, Rai Y, Saili A. Risk factors for carbapenem-resistant Acinetobacter baumanii blood stream infections in a neonatal intensive care unit, Delhi, India. J Infect Dev Ctries 2014; 8 (08) 1049-1054
- 5 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
- 6 Tekin R, Dal T, Bozkurt F. et al. Risk factors for nosocomial burn wound infection caused by multidrug resistant Acinetobacter baumannii . J Burn Care Res 2014; 35 (01) e73-e80
- 7 Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Disk Susceptibility Tests. Approved standard M2–A10. Wayne, PA: CLSI; 2009
- 8 Horan TC, Gaynes RP. Surveillance of nosocomial infection. In: Mayhall CG. ed. Hospital Epidemiology and Infection Control. 3rd ed.. Philadelphia: Lippincott Williams & Wilkins; 2004: 1659-1702
- 9 O'Grady NP, Alexander M, Dellinger EP. et al; Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR Recomm Rep 2002; 51 (RR-10): 1-29
- 10 Ekinci F, Bayram N, Devrim I, Apa H, Gülfidan G, Günay I. Estimating risk factors for Acinetobacter bacteremia in pediatric settings. Braz J Infect Dis 2013; 17 (04) 505-506
- 11 Touati A, Achour W, Cherif A. et al. Outbreak of Acinetobacter baumannii in a neonatal intensive care unit: antimicrobial susceptibility and genotyping analysis. Ann Epidemiol 2009; 19 (06) 372-378
- 12 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
- 13 Huang YC. Device-associated healthcare-associated infections in the neonatal intensive care unit. Pediatr Neonatol 2013; 54 (05) 293-294
- 14 Aktar F, Tekin R, Güneş A. et al. Determining the independent risk factors and mortality rate of nosocomial infections in pediatric patients. BioMed Res Int 2016; 2016: 7240864
- 15 Cevik S, Tekin R, Gundeslioglu ÖO, Aktar F, Yilmaz ŞM, Ay M. Evaluation of device-associated nosocomial infections in a paediatric intensive care unit. West Indian Med J 2015; 65 (02) 295-299
- 16 Karakoc C, Tekin R, Yeşilbağ Z, Cagatay A. Risk factors for mortality in patients with nosocomial gram-negative rod bacteremia. Eur Rev Med Pharmacol Sci 2013; 17 (07) 951-957
- 17 Celik IH, Demirel G, Tatar Aksoy H. et al. Acinetobacter baumannii: an important pathogen with multidrug resistance in newborns. Mikrobiyol Bul 2011; 45 (04) 716-722
- 18 Deveci Ö, Dal T, Tekin R, Bozkurt F, Tekin A, Dayan S. Carbapenem resistance in Acinetobacter baumannii: where is it heading?. Infez Med 2013; 21 (03) 211-215
- 19 İpek MS, Aktar F, Okur N, Celik M, Ozbek E. Colistin use in critically ill neonates: a case-control study. Pediatr Neonatol 2017; 58 (06) 490-496
- 20 Tekin R. Hospital infections and management in neonatal intensive care units. Pediatr Neonatal Care Open Access 2015; 3: 111
- 21 Ceylan B, Arslan F, Sipahi OR. et al. Variables determining mortality in patients with Acinetobacter baumannii meningitis/ventriculitis treated with intrathecal colistin. Clin Neurol Neurosurg 2017; 153: 43-49
- 22 Isik DU, BAŞ AY, Kulali F. et al. Nosocomial infection outbreak with Enterobacter aerogenes at a neonatal intensive care unit and its outcomes. J Pediatr Infect Dis 2019; 14: 223-227