Abstract
BackgroundAcinetobacter baumannii (AB) is critical for healthcare-associated infections (HAI) with significant regional differences in the resistance rate, but its risk factors and infection trends has not been well studied. We aimed to explore the risk factors, epidemiological characteristics and resistance of multidrug-resistant Acinetobacter baumannii (MDR-AB) in intensive care unit inpatients.MethodsData of patients with MDR-AB (195 cases), and with antibiotic-sensitive AB infection (294 cases, control) during January to December, 2015 in three medical centers in Xiamen, China were conducted and analyzed in the present retrospective study.ResultsLower respiratory tract infection with AB accounted for 68.71%. MDR-AB was detected in 39.88% of all cases. Univariate analysis suggested that mechanical ventilation, indwelling catheter, cancer patients, length of hospitalization in intensive care unit (ICU) ≥15 d, Acute Physiology and Chronic Health Evaluation (APACHE) II score, combined using antibiotic before isolation of AB and use of third-lines cephalosporins were associated with the development of MDR-AB healthcare-associated infections. Dose-response relationship analysis suggested that the age and the days of mechanical ventilation were associated with increased infection with MDR-AB. Logistic regression analysis suggested that, mechanical ventilation, combined using antibiotic before isolation of AB, and indwelling catheter, were associated with MDR-AB infection, with odds ratios (OR) and 95% confidence intervals (CI) of 3.93 (1.52–10.14), 4.11 (1.58–10.73), and 4.15 (1.32–12.99), respectively.ConclusionsMDR-AB infection was associated with mechanical ventilation, combined using antibiotic before isolation of AB, and indwelling catheter. Furthermore, the age and the days of mechanical ventilation were associated with increased infection with MDR-AB.
Highlights
Acinetobacter baumannii (AB) is critical for healthcare-associated infections (HAI) with significant regional differences in the resistance rate, but its risk factors and infection trends has not been well studied
Diagnostic criteria: The designation of MDR was defined as the absence of susceptibility to >3 of the following antimicrobials or groups of antimicrobials: ampicillin/sulbactam, aztreonam, ceftazidime, ciprofloxacin, gentamicin, imipenem, piperacillin, trimethoprim/sulfamethoxazole, carbapenems, and amikacin [12, 13].Bacterial isolation and antimicrobial susceptibility testing were performed in accordance with the methodology of the Clinical and Laboratory Standards Institute [14]
We showed that the incidence of multidrug-resistant Acinetobacter baumannii (MDR-AB) was 39.88% in intensive care units (ICU) inpatients, and was less than 56.3%, while more than 50% of the positive AB specimens were from sputum and lower respiratory tract infection was predominant
Summary
Acinetobacter baumannii (AB) is critical for healthcare-associated infections (HAI) with significant regional differences in the resistance rate, but its risk factors and infection trends has not been well studied. We aimed to explore the risk factors, epidemiological characteristics and resistance of multidrug-resistant Acinetobacter baumannii (MDR-AB) in intensive care unit inpatients. Acinetobacter baumannii (AB) is a Gram-negative, lactose non-fermenting organism and its ability to survive in hospital environments, which is increasingly becoming a major healthcare-associated infections (HAI) pathogen worldwide. Reports about multi-drug resistance Acinetobacter baumannii (MDR-AB) has been constantly increased, especially in the intensive care units (ICU) [2,3,4]. A recent study demonstrated that the 30-day hospital mortality rate of bloodstream infections caused by MDR-AB was 55.2% in geriatric inpatients [1].
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