Baumannii In Intensive Care Units Research Articles

Clinical Characteristics, Antibiotic Resistance Profiles, and Factors Affecting Mortality in Patients Isolated Acinetobacter Baumannii in Intensive Care Unit: Retrospective Tertiary Center Analysis

Clinical Characteristics, Antibiotic Resistance Profiles, and Factors Affecting Mortality in Patients Isolated Acinetobacter Baumannii in Intensive Care Unit: Retrospective Tertiary Center Analysis

Efficacy of combination therapy with standard-dose carbapenem for treating nosocomial pneumonia caused by carbapenem-resistant Acinetobacter baumannii in intensive care units: A multicentre retrospective propensity score-matched study

Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is common worldwide. Despite carbapenem resistance, standard-dose carbapenems are still used in clinical practice. Hence in this study, we aimed to compare the efficacy and outcomes of a regimen containing standard-dose carbapenems with those of a regimen lacking carbapenems during the treatment of critically ill patients with CRAB nosocomial pneumonia in the intensive care unit (ICU). Initially, 735 patients were recruited for this multicentre retrospective cohort study. After exclusion, time-window bias adjustment, and propensity score matching, multiple clinical outcomes were compared between the carbapenem-containing (CC) (n = 166) and no carbapenem-containing (NCC) (n = 166) groups. The CC group showed a higher risk of clinical failure on day 7 than the NCC group (44.6% vs. 33.1%, P = 0.043). The lengths of ICU stay (21 and 16 days, P = 0.024) and hospital stay (61 and 44 days, P = 0.003) were longer in the CC group than in the NCC group. Multivariate analysis showed that the CC regimen was associated with higher clinical failure (adjusted odds ratio (aOR) = 1.64, 95% CI = 1.05–2.56, P = 0.031) and lower microbiological eradication (aOR = 0.48, 95% CI = 0.23–1.00, P = 0.049) at day 7 than the NCC group. Thus, a regimen containing a standard dose of carbapenem should be prescribed with caution for treating CRAB nosocomial pneumonia in the ICU.

Analysis of the cases of infection by Acinetobacter baumannii in intensive care units in Alagoas between 2014 and 2018

Introduction: The infection by Acinetobacter baumannii, an aerobic, gram-negative, ubiquitous coccobacillus, assumes endemic proportions with notable spread in Intensive Care Units. Aim: To analyze the cases of Acinetobacter baumannii infection in Adult Intensive Care Units in Alagoas between 2014 and 2018. Outlining: A transversal, descriptive and retrospective research was carried out with sample of 120 patients. Data collection was carried out through a questionnaire in the documents of two public hospitals in the city of Maceió-Alagoas, one of these is a referral in emergence and the other is referral in infectious diseases. Results: Of the 120 patients, 80 (66.7%) were from Hospital A and 40 (33.3%) from Hospital B. There was a prevalence of males (71.7%) and of the 18 to 40 age range (49.2%) in both hospitals. The antibiotic meropenem showed a higher frequency of use. Antimicrobial resistance and sensitivity profiles were higher for cephalosporins, carbapenems, and fluoroquinolones, as well as aminoglycosides, respectively. The most frequent bacterial isolation material was the tracheal secretion associated with mechanical ventilation. The most mentioned outcome was death. Implications: The study exposed high rates of mortality and antimicrobial resistance, as well as evidence that can contribute to the implementation of prophylactic measures for Acinetobacter baumannii.

Reservoir of Carbapenem-Resistant Acinetobacter baumannii in the Hospital Environment and Colonization Pressure: A Surveillance-Based Study in Indian Intensive Care Unit.

The endemicity of Acinetobacter baumannii in intensive care units (ICUs) is a serious concern. We studied the reservoirs of A. baumannii in the ICU and their effects on colonization pressure and transmission. A prospective surveillance (6 months) was conducted. Screening culture (rectal and axillary) swabs were collected within 48 hours admission and in 120 hours. Surveillance cultures from patients' surroundings, health care workers (HCWs), and hospital sewage were collected. A. baumannii was identified by phenotypic and genotypic methods. Carbapenem resistance and insertion sequence element were detected. Typing was done by repetitive extragenic palindromic-polymerase chain reaction and multilocus sequence typing. Colonization pressure was calculated and compared with environment colonizers. Of the 87 patients, 21.83% (19) were colonized with A. baumannii, 73.68% (14/19) were imported, and 26.31% (5/19) acquired carriers. Axilla was the commonest site. From the environment (15), bed rails 33.33% (5/15) and suction tubes 26.66% (4/15) were the common sites. HCWs showed 7.5% (3/40) carriage. Carbapenem resistance with blaOXA-51, blaOXA-23, and ISAba1 were 91.89% (34/37). Strong correlation between colonization pressures and environmental colonizers was seen (r2 = 0.719, p = 0.032). Carbapenem and polymyxin B were (p ≤ 0.05) significant exposures. Sequence type 623 was the predominant cluster with isolates from carriers, HCWs, and environment. Colonization pressure of carbapenem-resistant A. baumannii depends on their presence in the hospital. Hands of HCWs were an important vehicle for transmission. Infection control measure should consider reducing the environmental reservoir.

The effect of chlorhexidine on Acinetobacter baumannii in intensive care units.

Background and Objectives:Measures to prevent the emergence of hospital-acquired infections (HAIs) include a daily bath with chlorhexidine gluconate (CHG). The aim of this study was to determine the effect of patients bathing daily with CHG on the bacterial colonization on patient surfaces, environmental surrounding areas, and attending healthcare workers (HCWs).Materials and Methods:Patients were randomized by a 1:1 in two groups. Patients in group 1 were bathed daily with CHG; patients in group 2 were bathed with a placebo. Microbiological sampling of patients, environment, and HCWs were carried out on days 0, 3, and 10. The clonal relatedness of selected isolates collected was determined through pulsed-field gel electrophoresis. Clinical and demographic data were obtained from medical files.Results:Thirty-three patients were included (18 in group 1 and 15 in group 2). The more common species was Acinetobacter baumannii (n=144), followed by Klebsiella pneumoniae (n=81). A. baumannii was isolated more frequently on environmental surfaces in group 2 than group 1 (day 0 vs. day 3 vs. day 10; p = 0.0388). Twelve clones of A. baumannii were detected, with predominant clone A detected in patients and environmental surfaces. No pathogens were detected in HCWs.Conclusion:Our data support that CHG bathing decreases A. baumannii surviving on the environmental surfaces of critically ill patients.

Oral colonization of Acinetobacter baumannii in intensive care units: Risk factors, incidence, molecular epidemiology, association with the occur of pneumonia and sepsis, and infection control measures.

Objective(s):Oral colonization of Acinetobacter baumannii can lead to infections such as pneumonia and sepsis. We aimed to evaluate oral colonization of hospitalized patients in ICUs and to examine risk factors for oral colonization, molecular epidemiology, and incidence of pneumonia and sepsis. Materials and Methods:The study began in February 2021. Oral cultures were taken. The microorganisms were identified by a Maldi-tof MS mass spectrometry device. Colistin resistance genes were investigated by polymerase chain reaction. Clonal relationships were determined by pulsed-field gel electrophoresis. Results: A. baumannii was found in 21 of 96 patients’ oral cultures. Pneumonia and sepsis due to A. baumannii were detected in 14 and 5 patients, respectively. The mean growth time of A. baumannii from oral cultures was 11.8 days, and the meantime for the occurrence of pneumonia after oral growth was 5.2 days. We determined a plasmid mediated mcr-2 colistin resistance gene in a colistin susceptible A. baumannii strain. It is the first report of the plasmid mediated mcr-2 colistin resistance gene in our country. In total, fourteen different A. baumannii genotypes were determined in PFGE. It was determined that the effects of antibiotic use, oral motor dysfunction, mechanical ventilation, intubation, orogastric tube use, and total parenteral nutrition intake on oral colonization were statistically significant.Conclusion:Oral colonization of A. baumannii is a significant concern in ICUs. We believe that it is important to take oral cultures and follow the risk factors and take infection control measures to prevent oral colonization of resistant isolates in ICUs.

High lethality rate of carbapenem-resistant Acinetobacter baumannii in Intensive Care Units of a Brazilian hospital: An epidemiologic surveillance study.

ABSTRACTBackground: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a growing threat to public health. Methods: A 3-year retrospective study was conducted to evaluate the prevalence and lethality of multidrug-resistant (MDR) A. baumannii isolated from Brazilian patients. Results: In this study, 219 Acinetobacter baumannii isolates were identified, of which 70.8% (155/219) were isolated from patients hospitalized in intensive care units. Of these, 57.4% (n = 89/155) were assessed, of which 92.1% (82/89) were carbapenem-resistant, and 49 were classified as infected. The lethality rate was 79.6% (39/49). Conclusions: We highlight the need of an effective epidemiological surveillance measure to contain the dissemination of CRAB in the hospital environment.

Molecular Characterization of Carbapenem-Resistant Acinetobacter baumannii in the Intensive Care Unit of Uruguay's University Hospital Identifies the First rmtC Gene in the Species.

Carbapenem-resistant Acinetobacter baumannii (CRAB) infections are an increasing concern in intensive care units (ICUs) worldwide. The combination of carbapenemases and 16S rRNA-methyltransferases (16S-RMTases) further reduces the therapeutic options. OXA-carbapenemase/A. baumannii clone tandems in Latin America have already been described; however, no information exists in this region regarding the occurrence of 16S-RMTases in this microorganism. In addition, the epidemiology of A. baumannii in ICUs and its associated resistance profiles are poorly understood. Our objectives were as follows: to study the clonal relationship and antibiotic resistance profiles of clinical and digestive colonizing A. baumannii isolates in an ICU, to characterize the circulating carbapenemases, and to detect 16S-RMTases. Patients admitted between August 2010 and July 2011 with a clinically predicted hospital stay > 48 hr were included. Pharyngeal and rectal swabs were obtained during the first fortnight after hospitalization. Resistance profiles were determined with MicroScan® and VITEK2 system. Carbapenemases and 16S-RMTases were identified by PCR and sequencing, and clonality was assessed by pulsed-field gel electrophoresis and multilocus sequence typing. Sixty-nine patients were studied and 63 were diagnosed with bacterial infections. Among these, 29 were CRAB isolates; 49 A. baumannii were isolated as digestive colonizers. These 78 isolates were clustered in 7 pulsetypes, mostly belonging to ST79. The only carbapenemase genes detected were blaOXA-51 (n = 78), blaOXA-23 (n = 62), and blaOXA-58 (n = 3). Interestingly, two clinical isolates harbored the rmtC 16S-RMTase gene. To the best of our knowledge, this is the first description of the presence of rmtC in A. baumannii.

Subsequent Multidrug-Resistant Bacteremia Is a Risk Factor for Short-Term Mortality of Patients with Ventilator-Associated Pneumonia Caused by Acinetobacter baumannii in Intensive Care Unit: A Multicenter Experience.

Subsequent Multidrug-Resistant Bacteremia Is a Risk Factor for Short-Term Mortality of Patients with Ventilator-Associated Pneumonia Caused by Acinetobacter baumannii in Intensive Care Unit: A Multicenter Experience.

SUCCESSFUL TREATMENT OF VENTILATOR ASSOCIATED PNEUMONIA CAUSED BY MULTIDRUG RESISTANT ACINETOBACTER BAUMANNII WITH A COMBINATION THERAPY OF CSE1034 AND COLISTIN: A CASE REPORT.

Objective: One of the major causes of ventilator-associated pneumonia (VAP) in hospital settings is Acinetobacter baumannii. The propensity of acquiring antimicrobial resistance rapidly through a multiple number of mechanisms makes the selection of an appropriate empirical antimicrobial agent exceedingly challenging for this pathogen.Methods: The present case report explores the option of treating VAP infection due to carbapenem-resistant pathogens with antibiotic adjuvant entities.Results: We present a case of VAP due to carbapenem-resistant A. baumannii that was successfully treated with CSE-1034 and colistin combination therapy.Conclusion: Early recognition and appropriate antibiotic therapy are essential to eliminate poor outcomes in multidrug-resistant (MDR) bacterial infections. The present case highlights the antibiotic adjuvant entity “CSE-1034” as an empiric option for the treatment of VAP due to MDR A. baumannii in intensive care unit.

Increased colistin resistance of Acinetobacter species in intensive care unit-acquired infections in a tertiary care hospital

Background: The aim of our study was to evaluate the antimicrobial resistance rates among pathogen microorganisms especially colistin resistant rates of Acinetobacter baumannii in intensive care unit (ICU)-acquired infections and to determine infection-specific correct treatment strategies.
 Methods: The data of adult and newborn infant patients diagnosed with ICU-acquired infection in a tertiary education and research hospital in Bursa in 2014 and 2016 were analyzed, retrospectively.
 Results: Acinetobacter baumannii was the most frequent pathogen of ICU-acquired infections in 2014 and 2016. There was a significant increase in colistin (CO) resistance rates in A. baumanii (0.0%-6.8%). A significant increase in CO, cefepime (FEP), ciprofloxacin (CIP) resistance rates was established in all gram negative bacteria (0.0%-7.9%, 50.0%-91.9%, 54.7%-74.6%), respectively. A significant increase in the rate of detection of A. baumanii as the pathogen microorganism in respiratory tract infection (RTI) was established (53.9% -79.5%). In addition, the average ventilator-associated pneumonia (VIP) infection rate also increased in 2016 compared to 2014 (VIP rate 2014: 7.12, 2016: 7.45, per 1000 ventilator days). A significant decrease in the rate of detection of all gram negative microorganisms in the surgical site infection (SSI), and a significant increase in the rate of detection of all gram positive microorganisms in the SSI was determined.
 Conclusion: Increased antimicrobial resistance, especially increased colistin resistance rates in ICU-acquired infections, necessitates the creation of new strategies in empirical therapy. Detection of antimicrobial resistance profiles of local and infectious pathogen microorganisms in ICUs is a good guide for correct antimicrobial management.

Emergence of Extensively Drug Resistant Acinetobacter baumannii-Encoding Integrons and Extended-Spectrum Beta-Lactamase Genes Isolated from Ventilator-Associated Pneumonia Patients

Background: Acinetobacter baumannii has increasingly become one of the most common pathogens causing ventilator-associated pneumonia (VAP). Objectives: In the present study, we aimed to assess the presence of extended-spectrum beta-lactamase (ESBL) and integron genes in A. baumannii isolates from VAP patients in the intensive care units (ICUs) of 18 hospitals in North of Iran. Methods: All patients, who were ventilated for at least 48 hours, were assessed daily for VAP. The minimum inhibitory concentrations were determined according to the standard protocol by the clinical and laboratory standards institute (CLSI). ESBL-producing A. baumannii was detected, using the double-disk synergy test. ESBL-positive A. baumannii isolates were screened for CTX, VEB, GES, SHV, int1, and int2 genes, using polymerase chain reaction (PCR) amplification. Results: In total, 29 out of 205 patients with nosocomial infections, admitted to ICUs during 2014 - 2015, showed VAP caused by ESBL-producing A. baumannii. A total of 19 (65.51%) strains were extensively drug resistant (XDR). As the findings revealed, the rates of imipenem and colistin resistance were 55.2% and 34.5%, respectively. The prevalence of CTX, VEB, and SHV genes in ESBL-producing A. baumannii was 34.5%, 17.2%, and 96.6%, respectively. Also, 79.3% of the isolates had class 1 integrons, while 10.3% contained class 2 integrons. Conclusions: Presence of integrons in A. baumannii has been considerably associated with ESBL genes. The high rate of SHV and int1 genes highlights the necessity of avoiding aminoglycosides for empirical therapy. Although colistin was the most sensitive antibiotic in XDR strains in our region, due to the presence of patients with A. baumannii in ICUs, colistin resistance screening should be performed before empirical therapy for VAP, even for those without prior exposure to this antibiotic.

The emergence of a novel sequence type of MDR Acinetobacter baumannii from the intensive care unit of an Egyptian tertiary care hospital

Background and aim of workAcinetobacter baumannii is known for nosocomial outbreaks worldwide. In this study, we aimed to investigate the antibiotic susceptibility patterns and the clonal relationship of A. baumannii isolates from the intensive care unit (ICU) of an Egyptian hospital.MethodsIn the present study, 50 clinical isolates of multidrug resistant (MDR)-A. baumannii were obtained from patients admitted into the ICU from June to December 2015. All isolates were analyzed for antimicrobial susceptibilities. Multiplex PCR was performed to detect genes encoding oxacillinase genes (blaOXA-51-like, blaOXA-23-like, blaOXA-24-like, and blaOXA-58-like). Multilocus sequence typing (MLST) based on the seven-gene scheme (gltA, gyrB, gdhB, recA, cpn60, gpi, rpoD) was used to examine these isolates.ResultsAll A. baumannii clinical isolates showed the same resistance pattern, characterized by resistance to most common antibiotics including imipenem (MIC ≥ 8μ/mL), with the only exception being colistin. Most isolates were positive for blaOXA-51-like and blaOXA-23-like (100 and 96%, respectively); however, blaOXA-24-like and blaOXA-58-like were not detected. MLST analysis identified different sequence types (ST195, ST208, ST231, ST441, ST499, and ST723) and a new sequence type (ST13929) with other sporadic strains.ConclusionsMDR A. baumannii strains harboring blaOXA-23-like genes were widely circulating in this ICU. MLST was a powerful tool for identifying and epidemiologically typing our strains. Strict infection control measures must be implemented to contain the worldwide spread of MDR A. baumannii in ICUs.

A study on antibiotics resistance and carbapenemase genotype of Acinetobacter baumannii in intensive care unit of Qingdao

Objective To investigate antibiotics resistant characteristics and carbapenemases genotype of Acinetobacter baumannii in Intensive Care Unit (ICU), so as to provide theoretical basis for clinical prevention and treatment. Methods Retrospective study was made on 90 non-duplicated clinical isolates of Acinetobacter baumannii, which were collected From January 2013 to January 2014 in three tertiary hospitals of Qingdao. All strains were identified by VITEK2 automated microbiology analyzer; K-B method was used to do drug susceptibility test; polymerase chain reaction (PCR) was used to amplify the OXA-23, OXA-24, OXA-51, OXA-58, KPC-2, VIM, IMP genes, and the positive products of genes were sequenced; the chi-square test was used to compare the difference of the resistance rates. Results The detection rate of multi-drug resistant A. baumannii (MDRAB)and Pan-drug resistant A. baumannii (PDRAB)was 61.11% (55/90) and 17.78% (16/90). In the 32 strains of imipenem-resistant Acinetobacter baumannii, the resistant rates to Cefoperazone/sulbactam, Polymyxin B was lower, while the resistant rates to other drugs tested were more than 85%. The difference of the resistance rates to 9 drugs between imipenem resistant group and Imipenem sensitive group were statistically significant (P≤0.05). PCR result showed: 32 strains detected OXA-51 gene, 28 strains detected OXA-23 gene, and 3 strains detected VIM gene, the detection rates of which were 100%, 87.50% and 9.38% respectively.All strains were not detected OXA-24, OXA-58, KPC-2 and IMP genes. The sequenced results were absolutely homology with the corresponding genes in genbank. Conclusions The resistance of A. baumannii in ICU is serious in this region, especially imipenem-resistant A. baumannii, which were nearly no-sensitive to most of the drugs commonly used in clinical. The gene existence of carbapenemase and carbapenemase producing is one of the main resistance mechanism of Acinetobacter baumannii to carbapenem antibiotics. OXA-23 was the major genotypes in this region.(Chin J Lab Med, 2017, 40: 216-220) Key words: Acinetobacter baumannii; Drug resistance, bacterial; Bacterial proteins; Beta-Lactamases; Genotype; Intensive care units

Successful control of outbreak caused by clonally related extensively-resistant Acinetobacter baumannii in an intensive care unit

Objective: Worldwide drug resistance in Acinetobacter baumannii is on the rise. We report outbreak of extensivelyresistant (XDR) A. baumannii in a medical intensive care unit (MICU) at a tertiary care referral hospital in Pakistan. During subsequent survey, 10 extensively-resistant A. baumannii were isolated from 8 environmental samples and hands of 2 healthcare workers (HCWs). Methods: In January 2013, XDR A. baumannii (Ab1, Ab2, and Ab3) were isolated from tracheal aspirate, blood and sputum of three patients with ventilator associated pneumonia. The isolates were resistant to piperacillin, ampicillinsulbactam, piperacillin-tazobactam, ticarcillin-clavulanic acid, ceftazidime, cefipime, ceftriaxone, imipenem, meropenem, gentamicin, amikacin, doxycycline, minocycline, ciprofloxacin and trimethoprim-sulphamethoxazole.. Pulsed Field Gel Electrophoresis (PFGE) revealed that isolates from HCWs were similar to the genotype initially isolated from patients’ samples. Results: Control of the outbreak was attained with requisite infection control practices and fumigation of the Medical ICU unit. From February 2013 to April 2013 there were no new cases of extensively-resistant isolates in medical ICU. However, two more cases with similar antibiogram MICs and genotype of extensively-resistant isolates emerged in June 2013 from the same MICU. Conclusion: Stringent infection control measures were implemented this time with continuous monitoring and regular surveillance. Follow up for the next two years has been successful as no clustering of XDR A. baumannii were detected from medical and surgical ICUs. J Microbiol Infect Dis 2017; 7(1): 1-6

Control of endemic extensively drug-resistant Acinetobacter baumannii with a cohorting policy and cleaning procedures based on the 1 room, 1 wipe approach

Our institution experienced an endemic situation with extensively drug-resistant (XDR) Acinetobacter baumannii in the intensive care units (ICUs). Here, we describe the long-term results of the implementation of a screening and cohorting policy and new cleaning techniques based on a procedure that we call the 1 room, 1 wipe approach. We conducted a 4-year quasi-experimental study in the ICUs of an 800-bed teaching hospital. The main actions implemented were active surveillance of XDR A baumannii and cohorting of carriers and introducing new cleaning techniques intended to avoid sharing wipes between rooms. XDR A baumannii significantly decreased from 132 cases in 2011 to 8 cases in 2014 and from 10.78 cases per 1,000 patient days in 2011 to 0.69 cases per 1,000 patient days in 2014. Segmented regression analysis showed that after implementing the measures, the monthly rates presented a sustained negative slope, with a significant change of -0.623 (P = .002). The prompt identification and isolation of patients and adequate environmental cleaning are effective measures for reducing XDR A baumannii in ICUs. The 1 wipe, 1 room approach should be considered a standard measure for cleaning hospital facilities to avoid cross-transmission as a result of reusable cleaning wipes.

The impact of inadequate terminal disinfection on an outbreak of imipenem-resistant Acinetobacter baumannii in an intensive care unit.

BackgroundThis study was conducted to investigate an outbreak caused by imipenem-resistant Acinetobacter baumannii (IRAB) in a medical intensive care unit (ICU) in a regional hospital.MethodsIn response to an IRAB outbreak from October 2012 to February 2013, we developed several infection control measures, including an extensive review process of environmental cleaning and disinfection, and used molecular methods to identify each clinical and environmental IRAB isolate.ResultsDuring this five-month period, 22 patients were colonized with IRAB and 18 patients had IRAB infections. The in-hospital mortality rate was significantly higher among patients with infections rather than colonizations (44.4% vs 9.1%, p = 0.028). Additionally, nine environmental specimens, including five specimens collected after terminal disinfection, were positive for IRAB. 12 environmental isolates and 28 of 36 available clinical isolates belonged to one unique pulsotype A, which was confirmed by molecular methods. We found the concentration of disinfectant, 0.08% sodium hypochlorite, was inadequate. After correcting the environmental cleansing methods, the surveillance study showed no further IRAB isolates on the control panel surfaces of the medical equipment or in patients in the ICU. Additionally, an in vitro study of IRAB immersed in different concentrations of sodium hypochlorite showed that 0.5% sodium hypochlorite eradicates IRAB after 30 seconds of inoculation, but 0.08% sodium hypochlorite only reduces the bacterial load.ConclusionsThis study highlights the importance of the preparation of disinfectants to adequately achieve environmental disinfection in the control of IRAB outbreaks in the ICU.

Impact of carbapenem resistance on clinical and economic outcomes among patients with Acinetobacter baumannii infection in Colombia

Acinetobacter baumannii is a major cause of healthcare-associated infection, often affecting critically ill patients. The purpose of the study was to examine the associations of carbapenem resistance with mortality, length of hospital stay and hospital costs among patients infected with A. baumannii in intensive-care units (ICUs) in Colombia. A prospective, multicentre cohort study was conducted among 165 patients with A. baumannii infection admitted to ICUs between April 2006 and April 2010. Patients with carbapenem-resistant A. baumannii had higher risk of 30-day mortality than patients with carbapenem-susceptible A. baumannii in the univariate analysis (unadjusted hazard ratio = 2.12; 95% CI 1.14–3.95; p 0.018). However, carbapenem resistance was not significantly associated with risk of mortality (adjusted hazard ratio = 1.45; 95% CI 0.74–2.87; p 0.28) after adjusting for APACHE II score and other confounding factors. We did not find a significant difference in length of stay in ICU after the onset of infection between the two groups in the multivariate analysis (adjusted mean = 13.1 days versus 10.5 days; p 0.14). The average total cost of hospitalization among patients with carbapenem-resistant A. baumannii was significantly higher than that among patients with carbapenem-susceptible A. baumannii in the multivariate analysis (adjusted cost; US$ 11 359 versus US$ 7049; p <0.001). Carbapenem resistance was not significantly associated with mortality, though we are unable to rule out an increased risk due to the limited sample size. Carbapenem resistance was associated with an additional cost of hospitalization.

Analysis of drug resistance of Acinetobacter baumannii and its related factors in ICU

To investigate drug resistance of Acinetobacter baumannii and its related factors in intensive care unit (ICU), and to provide clinical basis for prevention and treatment. A retrospective analysis was conducted. Clinical data was collected from 1 050 patients in ICU of Foshan Hospital of Traditional Chinese Medicine from January 2011 to June 2013. The risk factors of nosocomial infection were analyzed with univariate analysis. The independent risk factor was sieved from the risk factors with P<0.05 with unconditional logistic regression analysis to analyze the related factors and drug resistance of Acinetobacter baumannii in ICU. One hundred and thirteen patients suffering from nosocomial infection of Acinetobacter baumannii were found, and its incidence rate was 10.76%. There were 96 cases of infection of multi-drug resistant, extensive-drug resistant and pan-drug resistant Acinetobacter baumannii, accounting for 84.96%. Acinetobacter baumannii detection rate was 79.65% in sputum, 10.62% in urine, 4.42% in wound secretion, 3.54% in blood, and 1.77% in other drainage discharges, respectively. Univariate analysis showed that mechanical ventilation, ICU stay time≥7 days, coma [Glasgow coma score (GCS)<8], usage of broad-spectrum antibiotics were risk factors of nosocomial infection of Acinetobacter baumannii. Multivariate logistic analysis showed that the independent risk factors of nosocomial infection caused by Acinetobacter baumannii in ICU were mechanical ventilation [odds ratio (OR)= 2.957, 95%confidence interval (95%CI) 1.106-6.253, P=0.023], ICU stay time≥7 days (OR=2.991, 95%CI 1.135-6.544, P=0.022), coma (GCS<8,OR=2.894, 95%CI 1.803-7.462, P=0.010), and usage of broad-spectrum antibiotics (OR=3.054, 95%CI 1.009-6.550, P=0.004). Rate of resistance to polymyxin B was the lowest (6.19%), and it was followed by tobramycin and tigecycline, 11.50% and 28.32%, respectively. Acinetobacter baumannii in ICU was conditional pathogenic bacteria with high infection rate, and the lower respiratory tract was the main site of infestation. The related factors include mechanical ventilation, ICU stay time, coma, usage of broad-spectrum antibiotics. Its antimicrobial resistance rate was high. Comprehensive measures, including environmental isolation, strict bed unit disinfection, enforcement of hand disinfection, strengthening the effort to shorten the duration of mechanical ventilation, reduction of ICU length of stay, enhancement of drainage of mucus, excretions, and other body fluids, and rational use of antibiotics should be encouraged in order to reduce Acinetobacter baumannii in ICU.

Molecular Typing ofAcinetobacter baumanniiIsolated from Chinese Intensive Care Units Before and After the 2008 Sichuan Earthquake

Objective To trace the spread of Acinetobacter baumannii in intensive care units (ICUs) before and after the 2008 Sichuan earthquake in China. Methods A baumannii strains were collected between July and October 2007 from control patients and in May 2008 from survivors of the Sichuan earthquake. The multidrug resistance proflie of A baumannii was observed. The DiversiLab semi-automated rep-PCR system was used to determine the clonal relatedness of A baumannii strains; testing for antimicrobial susceptibility was performed using automated instruments. Results A total of 28 A baumannii strains were isolated, 13 of which had been isolated from control patients; 15 strains were isolated from earthquake survivors. Regardless of patient group, 2 clonal groups were observed in these isolates. The results demonstrate that most of the A baumannii isolates recovered from the earthquake survivors were similar to those obtained from the control patients. This suggests that A baumannii species, particularly those of clonal groups A and B (most of which are multidrug-resistant [MDR]), have been well established in our ICU; that earthquake survivors probably acquired A baumannii in the hospital setting; and that A baumannii recovered from earthquake survivors may bring different genetic profiles into contact with local isolates. Conclusions Our findings highlight the need for stronger infectioncontrol measures and emphasize the importance of rapid strain typing for monitoring pathogens such as A baumannii that are frequently associated with nosocomial infections. * MDR : multidrug-resistant ICU : intensive care unit rep-PCR : repetitive extragenetic palindromic sequence-based polymerase chain reaction CLSI : Clinical and Laboratory Standards Institute (CLSI)