Clinical study on Acinetobacter baumannii hospital-acquired pneumonia in pediatric intensive care unit

Abstract

Objective To investigate the occurrence, risk factors and antibiotic resistance characteristics of Acinetobacter baumannii hospital-acquired pneumonia (ABHAP) in the pediatric intensive care unit (PICU) for the guidance of clinical prevention and treatment of ABHAP. Methods Clinical data of the 91 children with hospital-acquired pneumonia (HAP) in the PICU of the West China Second University Hospital, Sichuan University were collected from September 2013 to September 2014. They were divided into study group (n=19) and control group (n=72) according to whether they were ABHAP or not. All patients′ age, gender, basic diseases, complications, immune function, the pediatric critical illness scores, hospital stay before HAP in PICU, detaining gastric tube, the duration of invasive mechanical ventilation, antibacterial drugs usage, infections with other pathogenic bacteria, drug sensitivity tests and treatment outcomes were analyzed by retrospective method. The distribution of pathogenic bacteria of children with HAP, the occurrence, antibiotic resistance characteristics and related risk factors of ABHAP in the children were analyzed by statistical methods. The procedure in this study was consistent with the Ethical Review Board of Investigation in West China Second University Hospital, Sichuan University and was approved by the committee. There were no significant differences in the age, gender ratio, pediatric critical illness score, basic disease and complications between the two groups (P>0.05). Results ①Among the 91 cases of children with HAP, a total of 159 strains of pathogenic bacteria were isolated, of which, there were 48 strains of Acinetobacter baumannii (AB). And 97.9% (47/48) of these 48 strains were derived from respiratory specimens. ②The resistance rate of AB to the common third-/fourth-generation cephalosporin all were over 70%, to imipenem, piperacillin/tazobactam, ampicillin/sulbactam and levofloxacin was 70.8% (34/48), 70.8% (34/48), 66.7% (32/48), and 27.1% (13/48), respectively. ③In study group, the rates of HAP patients with duration of hospitalization in PICU ≥ 15 days, duration of invasive mechanical ventilation ≥ 10 days, duration of broad-spectrum antibacterial therapy ≥ 7 days, and combined with congenital heart disease all were significantly higher than those in control group, and all the differences were statistically significant (P<0.05). Conclusions The present study shows high incidence of and severe drug-resistance to ABHAP in the PICU. Shortening the duration of hospitalization and invasive mechanical ventilation, rational use of antibiotics, early radical treatment of congenital heart disease, and prevention of recurrent pneumonia are helpful in preventing and treating ABHAP. Key words: Acinetobacter baumannii; Pneumonia, acquired; Risk factor; Antibiotic resistance; Child