Extensively Drug Resistant Acinetobacter Species From Burns Sepsis At A Tertiary Hospital In Northwest Nigeria: Case Series

Abstract

Background: Acinetobacter species are organisms with low virulence; however, they cause infections in immunocompromised patients. Studies of extensively drug resistant (XDR) Acinetobacter are rare in Nigeria. This organism poses a significant threat and challenge in the management of burns patients particularly as the pipeline for newer antimicrobials is drying up. Most available recommended antimicrobials are toxic, expensive and not readily available especially in low income countries. Case series: Case 1: A 25 year old nursing mother who presented with inhalational and 19.5% flame burns involving the head, neck, trunk, and both upper/lower limbs. She developed sepsis after eight days while on admission. Specimens (sputum, blood, tissue biopsy) all yielded Acinetobacter baumannii. Case 2: Is a 29 year old lady who had road traffic accident and was admitted with 38% flame burn injury involving both lower limbs, part of the upper limbs, buttocks, abdomen and the back. She developed sepsis ten days while on admission. Blood and tissue biopsy specimens yielded Acinetobacter baumannii. Case 3: A 29 year old male gas plant worker presented with inhalational and 63% flame burn injury involving both upper and lower limbs, trunk, neck, buttocks, back, and abdomen. He developed sepsis two weeks later while on admission. Blood and tissue biopsy specimens yielded Acinetobacter iwoffii. Specimens from all three (3) cases were processed using conventional biochemical and Microbact 24E identification system. Antimicrobial susceptibility testing was done using modified Kirby-Bauer single disc diffusion method, and results interpreted according to Clinical and Laboratory Standard Institute (CLSI) 2021 guidelines. Cases 1 and 3 were treated with combination antibiotherapy while case 2 had monotherapy. Conclusion: We present case series of three patients with difficult to manage burns sepsis caused by XDR Acinetobacter species. Combination antibiotherapy was effective. We recommend active surveillance of burns patients in all hospital as well as strengthening infection prevention and control practices