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Benaissa E, Belouad E, Maleb A, Elouennass M. Risk factors for acquiring Acinetobacter baumannii infection in the intensive care unit: experience from a Moroccan hospital. Access Microbiol 2023; 5:acmi000637.v3. [PMID: 37691842 PMCID: PMC10484316 DOI: 10.1099/acmi.0.000637.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Acinetobacter species are non-fermenting and ubiquitous Gram-negative coccobacilli, which in recent years have become the leading cause of healthcare-associated infections worldwide. Our objective here was to study the epidemiology and risk factors associated with Acinetobacter baumannii infections in the intensive care unit (ICU). Methods This retrospective case-control study was conducted collaboratively between the Medical Bacteriology Department and the two ICUs of the Military Hospital of Instruction Mohammed V-Rabat over a 3 month period. Results We included 180 patients, of whom 60 had A. baumannii infection. We observed a male predominance in both matched groups, with a sex ratio of 1.6. The median age was 67 years [interquartile range (IQR) 59.5-77]. The median length of stay in the ICU before infection was 8.5 days (IQR 5-14). Multivariate logistic regression analysis identified the risk factors statistically associated with A. baumannii infection at the ICU level as follows: duration of invasive procedures >7 days [odds ratio (OR)=1.02], parenteral nutrition (OR=3.514), mechanical ventilation (OR=3.024), imipenem (OR=18.72), colistin (OR=5.645), probabilistic antibiotic therapy >4 days (OR=9.063) and neoplastic pathology (OR=5.727). Conclusion Based on our results, it can be inferred that shortening the duration of stay in the resuscitation setting, implementing rational use of medical devices and optimizing antibiotic therapy could decrease the incidence of these infections.
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Affiliation(s)
- Elmostafa Benaissa
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
- Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Elmehdi Belouad
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Adil Maleb
- Laboratory of Microbiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy (University Mohammed the First), Oujda, Morocco
| | - Mostafa Elouennass
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
- Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
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Rojas-Larios F, Martínez-Guerra BA, López-Jácome LE, Bolado-Martínez E, Vázquez-Larios MDR, Velázquez-Acosta MDC, Romero-Romero D, Mireles-Dávalos CD, Quintana-Ponce S, Feliciano-Guzmán JM, Pérez-Hernandez JM, Correa-León YP, López-Gutiérrez E, Rodriguez-Noriega E, González-Díaz E, Choy-Chang EV, Mena-Ramírez JP, Monroy-Colín VA, Ponce-de-León-Garduño A, Alcaraz-Espejel M, Avilés-Benítez LK, Quintanilla-Cazares LJ, Ramírez-Alanís E, Barajas-Magallón JM, Padilla-Ibarra C, Ballesteros-Silva MB, Atanacio-Sixto NA, Morales-de-la-Peña CT, Galindo-Méndez M, Pérez-Vicelis T, Jacobo-Baca G, Moreno-Méndez MI, Mora-Pacheco MDLL, Gutiérrez-Brito M, Sánchez-Godínez XY, Navarro-Vargas NV, Mercado-Bravo LE, Delgado-Barrientos A, Santiago-Calderón MA, López-Ovilla I, Molina-Chavarria A, Rincón-Zuno J, Franco-Cendejas R, Miranda-Mauricio S, Márquez-Avalos IC, López-García M, Duarte-Miranda LS, Cetina-Umaña CM, Barroso-Herrera-Y-Cairo IE, López-Moreno LI, Garza-González E. Active Surveillance of Antimicrobial Resistance and Carbapenemase-Encoding Genes According to Sites of Care and Age Groups in Mexico: Results from the INVIFAR Network. Pathogens 2023; 12:1144. [PMID: 37764952 PMCID: PMC10537696 DOI: 10.3390/pathogens12091144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
We analyzed the antimicrobial resistance (AMR) data of 6519 clinical isolates of Escherichia coli (n = 3985), Klebsiella pneumoniae (n = 775), Acinetobacter baumannii (n = 163), Pseudomonas aeruginosa (n = 781), Enterococcus faecium (n = 124), and Staphylococcus aureus (n = 691) from 43 centers in Mexico. AMR assays were performed using commercial microdilution systems (37/43) and the disk diffusion susceptibility method (6/43). The presence of carbapenemase-encoding genes was assessed using PCR. Data from centers regarding site of care, patient age, and clinical specimen were collected. According to the site of care, the highest AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from ICU patients. In contrast, in A. baumannii, higher AMR was observed in isolates from hospitalized non-ICU patients. According to age group, the highest AMR was observed in the ≥60 years age group for E. coli, E. faecium, and S. aureus, and in the 19-59 years age group for A. baumannii and P. aeruginosa. According to clinical specimen type, a higher AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from blood specimens. The most frequently detected carbapenemase-encoding gene in E. coli was blaNDM (84%).
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Affiliation(s)
- Fabian Rojas-Larios
- Laboratorio de Microbiología, Hospital Regional Universitario de Colima, Colima 28040, Mexico
| | - Bernardo Alfonso Martínez-Guerra
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico
| | - Luis Esaú López-Jácome
- Servicio de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México 14389, Mexico
| | - Enrique Bolado-Martínez
- Departamento de Ciencias Químico-Biológicas, Universidad de Sonora, Hermosillo 83000, Mexico
| | - María Del Rosario Vázquez-Larios
- Laboratorio de Microbiología, Servicio de Infectología y Microbiología Cínica, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | | | | | - Christian Daniel Mireles-Dávalos
- Laboratorio de Microbiología Clínica, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - Sandra Quintana-Ponce
- Facultad de Ciencias Naturales, Universidad Autónoma de Guerrero, Chilpancingo 39000, Mexico
| | | | - José Miguel Pérez-Hernandez
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 66460, Mexico
| | - Yoselin Paola Correa-León
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 66460, Mexico
| | - Eduardo López-Gutiérrez
- Área de Microbiología, Laboratorio Clínico, Hospital Regional de alta Especialidad de Oaxaca, Oaxaca 71256, Mexico
| | - Eduardo Rodriguez-Noriega
- Instituto de Patología Infecciosa y Experimental, Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico
| | - Esteban González-Díaz
- Instituto de Patología Infecciosa y Experimental, Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico
- Departamento de Medicina Preventiva, Hospital Civil de Guadalajara, Fray Antonio Alcalde, Guadalajara 44280, Mexico
| | - Elena Victoria Choy-Chang
- Departamento de Bacteriología, Hospital General de Zona No.1 IMSS "Nueva Frontera", Tapachula 30767, Mexico
| | - Juan Pablo Mena-Ramírez
- Laboratorio de Microbiología, Hospital General de Zona No. 21 IMSS, Centro Universitario de los Altos (CUALTOS), Universidad de Guadalajara, Tepatitlán de Morelos 47630, Mexico
| | | | - Alfredo Ponce-de-León-Garduño
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico
| | | | - Laura Karina Avilés-Benítez
- Laboratorio de Microbiología y Parasitología, Hospital Infantil de Morelia "Eva Sámano de López Mateos", Morelia 58253, Mexico
| | | | | | | | - Cecilia Padilla-Ibarra
- Laboratorio Clínico, Hospital General de Estado "Dr. Ernesto Ramos Bours", Hermosillo 83000, Mexico
| | | | | | | | | | - Talía Pérez-Vicelis
- Hospital Regional de Alta Especialidad Bicentenario de la Independencia, Tultitlán 54916, Mexico
| | - Guillermo Jacobo-Baca
- Centro Universitario de Salud, Universidad Autónoma de Nuevo León, Monterrey 66460, Mexico
| | | | | | | | | | | | | | | | | | - Ismelda López-Ovilla
- Hospital Chiapas Nos Une Dr. Jesús Gilberto Gómez Maza, Tuxtla Gutiérrez 29045, Mexico
| | | | - Joaquín Rincón-Zuno
- Instituto Materno Infantil del Estado de México, Toluca de Lerdo 50170, Mexico
| | - Rafael Franco-Cendejas
- Servicio de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México 14389, Mexico
| | | | | | - Maribel López-García
- Hospital de la Madre y el Niño Guerrerense, Chilpancingo de los Bravo 39075, Mexico
| | | | | | | | | | - Elvira Garza-González
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 66460, Mexico
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Russell NJ, Stöhr W, Plakkal N, Cook A, Berkley JA, Adhisivam B, Agarwal R, Ahmed NU, Balasegaram M, Ballot D, Bekker A, Berezin EN, Bilardi D, Boonkasidecha S, Carvalheiro CG, Chami N, Chaurasia S, Chiurchiu S, Colas VRF, Cousens S, Cressey TR, de Assis ACD, Dien TM, Ding Y, Dung NT, Dong H, Dramowski A, DS M, Dudeja A, Feng J, Glupczynski Y, Goel S, Goossens H, Hao DTH, Khan MI, Huertas TM, Islam MS, Jarovsky D, Khavessian N, Khorana M, Kontou A, Kostyanev T, Laoyookhon P, Lochindarat S, Larsson M, Luca MD, Malhotra-Kumar S, Mondal N, Mundhra N, Musoke P, Mussi-Pinhata MM, Nanavati R, Nakwa F, Nangia S, Nankunda J, Nardone A, Nyaoke B, Obiero CW, Owor M, Ping W, Preedisripipat K, Qazi S, Qi L, Ramdin T, Riddell A, Romani L, Roysuwan P, Saggers R, Roilides E, Saha SK, Sarafidis K, Tusubira V, Thomas R, Velaphi S, Vilken T, Wang X, Wang Y, Yang Y, Zunjie L, Ellis S, Bielicki JA, Walker AS, Heath PT, Sharland M. Patterns of antibiotic use, pathogens, and prediction of mortality in hospitalized neonates and young infants with sepsis: A global neonatal sepsis observational cohort study (NeoOBS). PLoS Med 2023; 20:e1004179. [PMID: 37289666 PMCID: PMC10249878 DOI: 10.1371/journal.pmed.1004179] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 01/19/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND There is limited data on antibiotic treatment in hospitalized neonates in low- and middle-income countries (LMICs). We aimed to describe patterns of antibiotic use, pathogens, and clinical outcomes, and to develop a severity score predicting mortality in neonatal sepsis to inform future clinical trial design. METHODS AND FINDINGS Hospitalized infants <60 days with clinical sepsis were enrolled during 2018 to 2020 by 19 sites in 11 countries (mainly Asia and Africa). Prospective daily observational data was collected on clinical signs, supportive care, antibiotic treatment, microbiology, and 28-day mortality. Two prediction models were developed for (1) 28-day mortality from baseline variables (baseline NeoSep Severity Score); and (2) daily risk of death on IV antibiotics from daily updated assessments (NeoSep Recovery Score). Multivariable Cox regression models included a randomly selected 85% of infants, with 15% for validation. A total of 3,204 infants were enrolled, with median birth weight of 2,500 g (IQR 1,400 to 3,000) and postnatal age of 5 days (IQR 1 to 15). 206 different empiric antibiotic combinations were started in 3,141 infants, which were structured into 5 groups based on the World Health Organization (WHO) AWaRe classification. Approximately 25.9% (n = 814) of infants started WHO first line regimens (Group 1-Access) and 13.8% (n = 432) started WHO second-line cephalosporins (cefotaxime/ceftriaxone) (Group 2-"Low" Watch). The largest group (34.0%, n = 1,068) started a regimen providing partial extended-spectrum beta-lactamase (ESBL)/pseudomonal coverage (piperacillin-tazobactam, ceftazidime, or fluoroquinolone-based) (Group 3-"Medium" Watch), 18.0% (n = 566) started a carbapenem (Group 4-"High" Watch), and 1.8% (n = 57) a Reserve antibiotic (Group 5, largely colistin-based), and 728/2,880 (25.3%) of initial regimens in Groups 1 to 4 were escalated, mainly to carbapenems, usually for clinical deterioration (n = 480; 65.9%). A total of 564/3,195 infants (17.7%) were blood culture pathogen positive, of whom 62.9% (n = 355) had a gram-negative organism, predominantly Klebsiella pneumoniae (n = 132) or Acinetobacter spp. (n = 72). Both were commonly resistant to WHO-recommended regimens and to carbapenems in 43 (32.6%) and 50 (71.4%) of cases, respectively. MRSA accounted for 33 (61.1%) of 54 Staphylococcus aureus isolates. Overall, 350/3,204 infants died (11.3%; 95% CI 10.2% to 12.5%), 17.7% if blood cultures were positive for pathogens (95% CI 14.7% to 21.1%, n = 99/564). A baseline NeoSep Severity Score had a C-index of 0.76 (0.69 to 0.82) in the validation sample, with mortality of 1.6% (3/189; 95% CI: 0.5% to 4.6%), 11.0% (27/245; 7.7% to 15.6%), and 27.3% (12/44; 16.3% to 41.8%) in low (score 0 to 4), medium (5 to 8), and high (9 to 16) risk groups, respectively, with similar performance across subgroups. A related NeoSep Recovery Score had an area under the receiver operating curve for predicting death the next day between 0.8 and 0.9 over the first week. There was significant variation in outcomes between sites and external validation would strengthen score applicability. CONCLUSION Antibiotic regimens used in neonatal sepsis commonly diverge from WHO guidelines, and trials of novel empiric regimens are urgently needed in the context of increasing antimicrobial resistance (AMR). The baseline NeoSep Severity Score identifies high mortality risk criteria for trial entry, while the NeoSep Recovery Score can help guide decisions on regimen change. NeoOBS data informed the NeoSep1 antibiotic trial (ISRCTN48721236), which aims to identify novel first- and second-line empiric antibiotic regimens for neonatal sepsis. TRIAL REGISTRATION ClinicalTrials.gov, (NCT03721302).
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Affiliation(s)
- Neal J. Russell
- Center for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Wolfgang Stöhr
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Nishad Plakkal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Aislinn Cook
- Center for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | - James A. Berkley
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Bethou Adhisivam
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Ramesh Agarwal
- Newborn Division and WHO-CC, All India Institute of Medical Sciences, New Delhi, India
| | - Nawshad Uddin Ahmed
- Child Health Research Foundation (CHRF), Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Manica Balasegaram
- Global Antibiotic Research and Development Partnership (GARDP), Geneva, Switzerland
| | - Daynia Ballot
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | | | | | | | - Cristina G. Carvalheiro
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Neema Chami
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Suman Chaurasia
- All India Institute of Medical Sciences, Department of Paediatrics, New Delhi, India
| | - Sara Chiurchiu
- Academic Hospital Paediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | | | - Simon Cousens
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tim R. Cressey
- PHPT/IRD-MIVEGEC, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Tran Minh Dien
- Vietnam National Children’s Hospital, Hanoi, Vietnam and Surgical Intensive Care Unit, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Yijun Ding
- Vietnam National Children’s Hospital, Hanoi, Vietnam and Surgical Intensive Care Unit, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Nguyen Trong Dung
- Vietnam National Children’s Hospital, Hanoi, Vietnam and Surgical Intensive Care Unit, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Han Dong
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Madhusudhan DS
- Neonatology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Ajay Dudeja
- Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Children’s Hospital, New Delhi, India
| | - Jinxing Feng
- Department of Neonatology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Youri Glupczynski
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
| | - Srishti Goel
- Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Children’s Hospital, New Delhi, India
| | - Herman Goossens
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
| | - Doan Thi Huong Hao
- Vietnam National Children’s Hospital, Hanoi, Vietnam and Surgical Intensive Care Unit, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Mahmudul Islam Khan
- Child Health Research Foundation (CHRF), Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Tatiana Munera Huertas
- Center for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | | | - Daniel Jarovsky
- Pediatric Infectious Diseases Unit, Santa Casa de São Paulo, São Paulo, Brazil
| | - Nathalie Khavessian
- Global Antibiotic Research and Development Partnership (GARDP), Geneva, Switzerland
| | - Meera Khorana
- Neonatal Unit, Department of Pediatrics, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Angeliki Kontou
- Neonatology Dept, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - Tomislav Kostyanev
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
| | | | | | - Mattias Larsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Maia De Luca
- Academic Hospital Paediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | | | - Nivedita Mondal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Nitu Mundhra
- Neonatology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Philippa Musoke
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University and MUJHU Care, Kampala, Uganda
| | - Marisa M. Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ruchi Nanavati
- Neonatology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Firdose Nakwa
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sushma Nangia
- Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Children’s Hospital, New Delhi, India
| | - Jolly Nankunda
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Borna Nyaoke
- Global Antibiotic Research and Development Partnership (GARDP), Geneva, Switzerland
| | - Christina W. Obiero
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Amsterdam UMC, University of Amsterdam, Emma Children’s Hospital, Department of Global Health, Amsterdam, the Netherlands
| | - Maxensia Owor
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Wang Ping
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | | | - Shamim Qazi
- World Health Organization, Maternal, Newborn, Child and Adolescent Health Department, Geneva, Switzerland
| | - Lifeng Qi
- Department of Infectious Diseases, Shenzhen Children’s Hospital, Shenzhen, China
| | - Tanusha Ramdin
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Amy Riddell
- Center for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Lorenza Romani
- Academic Hospital Paediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Praewpan Roysuwan
- PHPT/IRD-MIVEGEC, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Robin Saggers
- Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Dept Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - Samir K. Saha
- Child Health Research Foundation (CHRF), Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Kosmas Sarafidis
- Neonatology Dept, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - Valerie Tusubira
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University and MUJHU Care, Kampala, Uganda
| | - Reenu Thomas
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tuba Vilken
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
| | - Xiaojiao Wang
- Department of Neonatology, Beijing Children’s Hospital, Capital Medical University, National Centre for Children’s Health, Beijing, China
| | - Yajuan Wang
- Department of Neonatology, Children’s Hospital, Capital Institute of Pediatrics, Yabao Road, Chaoyang District, Beijing, China
| | - Yonghong Yang
- Department of Neonatology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Liu Zunjie
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Sally Ellis
- Global Antibiotic Research and Development Partnership (GARDP), Geneva, Switzerland
| | - Julia A. Bielicki
- Center for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | - A. Sarah Walker
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Paul T. Heath
- Center for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Mike Sharland
- Center for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
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Alrahmany D, Omar AF, Alreesi A, Harb G, Ghazi IM. Acinetobacter baumannii Infection-Related Mortality in Hospitalized Patients: Risk Factors and Potential Targets for Clinical and Antimicrobial Stewardship Interventions. Antibiotics (Basel) 2022; 11:antibiotics11081086. [PMID: 36009955 PMCID: PMC9405145 DOI: 10.3390/antibiotics11081086] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022] Open
Abstract
Due to resistance and scarcity of treatment options, nosocomial Acinetobacter baumannii infections are associated with significant fatality rates. We investigated the factors contributing to infection-related deaths to develop tailored stewardship interventions that could reduce these high mortality rates. We reviewed the medical records of adult inpatients with A. baumannii infections over two years. Patient demographics and clinical data were collected and statistically analyzed. The study included 321 patients with positive A. baumannii microbiological cultures, with respiratory infections accounting for 58.6%, soft tissues 29.3%, bacteremia 8.6%, urine 2.1%, and others 1.4%. The study population’s median (IQR) age was 62.6 (38.9−94.9) years, and hospital stay was 20 (9.5−40) days. Statistical analysis revealed that various risk factors contribute significantly to high in-hospital all-cause mortality (44%), as well as 14-day and 28-day mortality rates. Deaths increased by a factor of 1.04 with every additional year of age (p = 0.000), admission to the critical care unit (p = 0.000, OR: 2.86), and patients admitted with an infectious diagnosis had nearly three times the mortality rate as those admitted with other diagnoses (p = 0.000, OR: 3.12). Male gender (p < 0.001, OR: 2.14), any comorbid conditions (p = 0.000, OR: 5.29), prolonged hospitalization (>7 days) (p = 0.023, OR: 1.98), and hospital acquisition of infection (p = 0.027, OR: 1.68) were among the most significant predictors of mortality. All variables were investigated for their impact on all-cause, 14-day, and 28-day mortality rates. Improving multidisciplinary infection control practices, regular disinfection of patient care equipment, and optimal intubation practice that avoids unnecessary intubation are necessary interventions to reduce infection-related mortality rates. Better antibiotic selection and de-escalation, shorter hospital stays whenever possible, prompt medical stabilization of comorbid conditions, and fewer unnecessary admissions to critical care units will all lead to improved outcomes.
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Affiliation(s)
- Diaa Alrahmany
- Pharmaceutical Care Department, Directorate General of Medical Supplies, Ministry of Health, Muscat 3110, Oman
| | - Ahmed F. Omar
- General Medicine Department, Suhar Hospital, Suhar 8484, Oman
| | - Aisha Alreesi
- Pharmacy Department, Suhar Hospital, Suhar 8484, Oman
| | | | - Islam M. Ghazi
- Arnold and Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, NY 11201, USA
- Correspondence: ; Tel.: + 1-215-268-8908
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5
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Abstract
BACKGROUND Acinetobacter baumannii sepsis constitutes an extreme threat with a poor prognosis and is a difficult infection to control, especially in Asia. Moreover, a knowledge gap in the risk of mortality in neonatal A. baumannii sepsis still exists. METHODS This study aimed to identify the risk factors of mortality in neonates with A. baumannii sepsis in Thailand from 1996 to 2019. A multivariable logistic regression model was analyzed for nonsurvivors and survivors of neonatal A. baumannii sepsis. RESULTS In a 24-year period, 91 neonates with A. baumannii sepsis were reviewed. The median (interquartile range) gestational age and birth weight were 33 (28.5, 37.5) weeks and 1740 (987.5, 2730.0) g, respectively. The 30-day case fatality rate was 36.3% (33/91). In univariable analysis, nonsurvivors of neonatal A. baumannii sepsis was associated with smaller neonates, lower Apgar scores, septic shock, mechanical ventilation, umbilical catheterization, neutropenia, severe thrombocytopenia, carbapenem-resistant A. baumannii sepsis, inadequate empiric antimicrobial therapy, and acute kidney injury. In multivariable analysis, nonsurvivors of neonatal A. baumannii sepsis were associated with septic shock (adjusted odds ratio [OR] = 41.38; 95% confidence intervals [CI]: 3.42-501.13; P = 0.003), severe thrombocytopenia (adjusted OR = 33.70; 95% CI: 3.44-330.55; P = 0.002), and inadequate empiric antimicrobial therapy (adjusted OR = 10.05; 95% CI: 1.40-71.98; P = 0.02). CONCLUSION In high multidrug-resistant areas, empiric treatment with broader spectrum antimicrobials should be considered in neonates with sepsis shock or severe thrombocytopenia.
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6
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Xu X, Xu C, Salisu RB, Xu W. Beta-Lactamase Gene Expression Level of Hospital-Acquired CRAB Isolated from Children in Picu. Infect Drug Resist 2021; 14:3195-3205. [PMID: 34429619 PMCID: PMC8378911 DOI: 10.2147/idr.s322604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Acinetobacter baumannii is a major cause of hospital-acquired infections. Studies showed that carbapenem resistance was related to mortality. Carbapenem resistance depends on expression of β-lactamase in adults. The present study explores the relationship between β-lactamase gene expression and carbapenem resistance and outcomes in children with A. baumannii infections. Patients and Methods We gathered clinical data of 131 children diagnosed with hospital-associated A. baumannii infections from the pediatrics unit of Shengjing Hospital of China Medical University. We obtained 131 isolates of A. baumannii, determined the minimal inhibitory concentrations (MICs) for common antibiotics, and measured carbapenemase-encoding genes expression using real-time PCR. Results We isolated 131 strains, 89 of which were carbapenem-resistant (MIC ≥ 8 µg/mL), and 42 carbapenem-sensitive strains. Univariate analysis identified statistically significant differences between the carbapenem-resistant group and the carbapenem-sensitive group for in-hospital days before infection, previous deep vein catheterization, previous urinary catheterization, previous treatment with a carbapenem (meropenem/imipenem), and expression of oxa-51 and oxa-23. Logistic regression analysis of factors associated with carbapenem-resistant A. baumannii infections found significant associations with oxa-23 expression (hazard ratio [HR] 0.005, confidence interval [CI] 95% 0-0.153, P = 0.002) and previous carbapenem treatment (HR 0.031 CI 95% 0.1-0.959, P = 0.042). Of 131 patients, 27 died within 30 days. Cox regression analysis of factors associated with 30-day mortality from A. baumannii infections showed that cephalosporin combined with sulbactam (HR 0.271, CI 95% 0.101-0.723, P = 0.009) was associated with 30-day survival. Conclusion The expression of oxa-23 and the use of carbapenems were independent risk factors for carbapenem resistance. The use of cephalosporins combined with sulbactam was independently associated with 30-day survival. We recommend using cephalosporins combined with sulbactam in children infected with A. baumannii.
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Affiliation(s)
- Xiao Xu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Caifang Xu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Rabiu Bilya Salisu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Wei Xu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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7
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Cook A, Hsia Y, Russell N, Sharland M, Cheung K, Grimwood K, Cross J, Cotrim da Cunha D, Magalhães GR, Renk H, Hindocha A, McMaster P, Okomo U, Darboe S, Alvarez-Uria G, Jinka DR, Murki S, Kandraju H, Dharmapalan D, Esposito S, Bianchini S, Fukuoka K, Aizawa Y, Jimenez-Juarez RN, Ojeda-Diezbarroso K, Pirš M, Rožič M, Anugulruengkitt S, Jantarabenjakul W, Cheng CL, Jian BX, Spyridakis E, Zaoutis T, Bielicki J. Association of Empiric Antibiotic Regimen Discordance With 30-Day Mortality in Neonatal and Pediatric Bloodstream Infection-A Global Retrospective Cohort Study. Pediatr Infect Dis J 2021; 40:137-143. [PMID: 33395208 DOI: 10.1097/inf.0000000000002910] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While there have been studies in adults reporting discordant empiric antibiotic treatment associated with poor outcomes, this area is relatively unexplored in children and neonates despite evidence of increasing resistance to recommended first-line treatment regimens. METHODS Patient characteristics, antibiotic treatment, microbiology, and 30-day all-cause outcome from children <18 years with blood-culture-confirmed bacterial bloodstream infections (BSI) were collected anonymously using REDCap™ through the Global Antibiotic Prescribing and Resistance in Neonates and Children network from February 2016 to February 2017. Concordance of early empiric antibiotic treatment was determined using European Committee on Antimicrobial Susceptibility Testing interpretive guidelines. The relationship between concordance of empiric regimen and 30-day mortality was investigated using multivariable regression. RESULTS Four hundred fifty-two children with blood-culture-positive BSI receiving early empiric antibiotics were reported by 25 hospitals in 19 countries. Sixty percent (273/452) were under the age of 2 years. S. aureus, E. coli, and Klebsiella spp. were the most common isolates, and there were 158 unique empiric regimens prescribed. Fifteen percent (69/452) of patients received a discordant regimen, and 7.7% (35/452) died. Six percent (23/383) of patients with concordant regimen died compared with 17.4% (12/69) of patients with discordant regimen. Adjusting for age, sex, presence of comorbidity, unit type, hospital-acquired infections, and Gram stain, the odds of 30-day mortality were 2.9 (95% confidence interval: 1.2-7.0; P = 0.015) for patients receiving discordant early empiric antibiotics. CONCLUSIONS Odds of mortality in confirmed pediatric BSI are nearly 3-fold higher for patients receiving a discordant early empiric antibiotic regimen. The impact of improved concordance of early empiric treatment on mortality, particularly in critically ill patients, needs further evaluation.
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Affiliation(s)
- Aislinn Cook
- From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom
| | - Yingfen Hsia
- From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom
| | - Neal Russell
- From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom
| | - Mike Sharland
- From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom
| | | | - Keith Grimwood
- Gold Coast Health, Gold Coast, QLD, Australia
- Griffith University, QLD, Australia
| | - Jack Cross
- Gold Coast Health, Gold Coast, QLD, Australia
| | - Denise Cotrim da Cunha
- Hospital Infection Control Service of Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Gloria Regina Magalhães
- Hospital Infection Control Service of Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Hanna Renk
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Avni Hindocha
- North Manchester General Hospital, Manchester, United Kingdom
| | - Paddy McMaster
- North Manchester General Hospital, Manchester, United Kingdom
| | - Uduak Okomo
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saffiatou Darboe
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gerardo Alvarez-Uria
- Department of Infectious Diseases, RDT Hospital, Anantapur, Andhra Pradesh, India
| | - Dasaratha R Jinka
- Department of Infectious Diseases, RDT Hospital, Anantapur, Andhra Pradesh, India
| | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | | | - Dhanya Dharmapalan
- Dr. Yewale's Multispecialty Hospital for Children, Vashi, Navi Mumbai, India
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Sonia Bianchini
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Kahoru Fukuoka
- Division of Infectious Diseases, Department of Paediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuta Aizawa
- Division of Infectious Diseases, Department of Paediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Rodolfo Norberto Jimenez-Juarez
- Infectious Diseases Department, Federico Gómez Children's Hospital of Mexico, Mexico City, Mexico
- Department of Pediatrics, Infectious Diseases Hospital, national Medical Center "La Raza", Mexican Institute of Social Security, Mexico City, Mexico
| | - Karla Ojeda-Diezbarroso
- Infectious Diseases Department, Federico Gómez Children's Hospital of Mexico, Mexico City, Mexico
| | - Mateja Pirš
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mojca Rožič
- Department of Infectious Diseases and Epidemiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Suvaporn Anugulruengkitt
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Watsamon Jantarabenjakul
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Ching-Lan Cheng
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Pharmacy, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Bai-Xiu Jian
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Evangelos Spyridakis
- University of Florida College of Medicine, Gainesville, FL
- The Studer Family Children's Hospital at Ascension Sacred Heart, Pensacola, FL
| | - Theoklis Zaoutis
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julia Bielicki
- From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom
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8
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Kurihara MNL, de Sales RO, da Silva KE, Maciel WG, Simionatto S. Multidrug-resistant Acinetobacter baumannii outbreaks: a global problem in healthcare settings. Rev Soc Bras Med Trop 2020; 53:e20200248. [PMID: 33174956 PMCID: PMC7670754 DOI: 10.1590/0037-8682-0248-2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/02/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The increase in the prevalence of multidrug-resistant Acinetobacter baumannii infections in hospital settings has rapidly emerged worldwide as a serious health problem. METHODS This review synthetizes the epidemiology of multidrug-resistant A. baumannii, highlighting resistance mechanisms. CONCLUSIONS Understanding the genetic mechanisms of resistance as well as the associated risk factors is critical to develop and implement adequate measures to control and prevent acquisition of nosocomial infections, especially in an intensive care unit setting.
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Affiliation(s)
| | - Romário Oliveira de Sales
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa
em Ciências da Saúde, Dourados, MS, Brasil
| | - Késia Esther da Silva
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa
em Ciências da Saúde, Dourados, MS, Brasil
| | - Wirlaine Glauce Maciel
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa
em Ciências da Saúde, Dourados, MS, Brasil
| | - Simone Simionatto
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa
em Ciências da Saúde, Dourados, MS, Brasil
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Memon UA, Ahmed AR, Khalid M, Qadir K, Jabbar N, Junejo S, Haque AU. Clinical profile and outcome of carbapenem-resistant gram negative bacteremia in children with cancer in pediatric intensive care unit of a resource-limited country. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2020. [DOI: 10.1016/j.phoj.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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10
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Kumari M, Batra P, Malhotra R, Mathur P. A 5-year surveillance on antimicrobial resistance of Acinetobacter isolates at a level-I trauma centre of India. J Lab Physicians 2020; 11:34-38. [PMID: 30983800 PMCID: PMC6437826 DOI: 10.4103/jlp.jlp_72_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION: Acinetobacter spp. has emerged as a major cause of nosocomial outbreaks. Multiple antibiotic resistance is an important problem in Acinetobacter isolates in recent years. The aim of this study was to evaluate the rate of antimicrobial resistance and changes in resistance pattern over a period of 5 years (2012–2016) in Acinetobacter spp. isolated from trauma patients. MATERIALS AND METHODS: Acinetobacter spp. was identified by VITEK 2 and antibiotic susceptibility of isolates was investigated by disc-diffusion method and VITEK 2 automated system. Interpretation of susceptibility results was based on the Clinical and Laboratory Standards Institute guidelines. RESULTS: Out of the total 16,210 isolates obtained throughout the period of 5 years, Acinetobacter spp. accounted for 3744 (28.9%). Out of which, the species which was maximally isolated was Acinetobacterbaumannii (98.5%), followed by Acinetobacterlwoffii (1.4%) and Acinetobacterhemolyticus (0.1%). The highest number of clinical isolates of Acinetobacter were recovered from neurosurgical ward (n = 1210), followed by the neurosurgical intensive care unit (ICU) (n = 1000) and surgical ICU (n = 948) and the most common sample of Acinetobacter isolation was from tracheal aspirate (37.1%), followed by wound swab (18.8%). The highest level of resistance was observed against ciprofloxacin (96%), followed by cefepime (95%), ceftazidime (95%), piperacillin (95%), and amikacin (92%). The trend of antibiotic resistance was found to be statistically significant (P < 0.001) for most of the antibiotics being tested such as amikacin and carbapenems. CONCLUSION: The high rate of antibiotic resistance of the Acinetobacter strains indicated that there is an urgent need for controlled antibiotic usage and appliance of hospital infection control measures.
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Affiliation(s)
- Minu Kumari
- Division of Trauma Surgery and Critical Care, JPNATC, AIIMS, New Delhi, India
| | - Priyam Batra
- Department of Microbiology, JPNATC, AIIMS, New Delhi, India
| | | | - Purva Mathur
- Department of Laboratory Medicine, JPNATC, AIIMS, New Delhi, India
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11
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Nazir A. Multidrug-resistant Acinetobacter septicemia in neonates: A study from a teaching hospital of Northern India. J Lab Physicians 2020; 11:23-28. [PMID: 30983798 PMCID: PMC6437821 DOI: 10.4103/jlp.jlp_129_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: Acinetobacter species are typical nosocomial pathogens causing infections and high mortality, almost exclusively in compromised hospitalized patients. Acinetobacter sp. are intrinsically less susceptible to antibiotics and have propensity to acquire resistance. Multidrug-resistant (MDR) Acinetobacter sp. blood infection in the neonatal intensive care unit patients create a great problem in hospital settings. AIMS: A prospective data analysis was performed over a one year period of all neonates admitted with sepsis who developed Acinetobacter infection and their antibiotic susceptibility pattern was carried out. MATERIALS AND METHODS: Blood samples of infected neonates were collected aseptically and cases of Acinetobacter septicemia were identified. Speciation of Acinetobacter species was done. Various risk factors were identified and their drug-sensitivity test was performed. RESULTS: The incidence of neonatal septicemia due to Acinetobacter species was 13.7% (49/357). Predominant species isolated was Acinetobacterbaumannii (98%). The major symptoms were lethargy and poor feeding. The major signs were tachypnea, intercostal retraction, and respiratory distress. The major fetal risk factors were low birth weight and prematurity. High degree of resistance was observed to the various antibiotics used. Majority of the isolates (95.9%) were MDR while 93.68% were resistant to carbapenems as well as extensively drug resistant. However, all the strains were sensitive to colistin. CONCLUSION: MDR Acinetobacter septicemia in neonatal patients is becoming alarmingly frequent and is associated with significant mortality and morbidity. Therefore, rational antibiotic use is mandatory along with an effective infection control policy in neonatal intensive care areas of each hospital to control Acinetobacter infection and improve outcome.
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Affiliation(s)
- Asifa Nazir
- Department of Microbiology, Government Medical College, Srinagar, Jammu and Kashmir, India
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12
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Park SY, Si HJ, Eom JS, Lee JS. Survival of carbapenem-resistant Acinetobacter baumannii bacteremia: colistin monotherapy versus colistin plus meropenem. J Int Med Res 2019; 47:5977-5985. [PMID: 31612764 PMCID: PMC7045657 DOI: 10.1177/0300060519879336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective The aim of this study was to compare clinical outcomes between patients with carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia treated with colistin monotherapy and those treated with colistin plus meropenem. Methods We retrospectively evaluated data from 71 patients with CRAB bacteremia treated from November 2006 to February 2018. Predictors of 14-day mortality were determined through logistic regression analysis. Results Our study cohort included 40 bacteremia patients (44.6 %) treated with colistin monotherapy and 31 (55.4 %) treated with colistin plus meropenem. Overall 14-day mortality tended to be higher with monotherapy rather than combination therapy (47.5% vs 25.8%). The latter also showed a tendency for higher clinical success rate compared with monotherapy (61.3% vs 40.0%). Logistic regression analysis showed that Pitt bacteremia score, pneumonia, and combination therapy were significantly associated with mortality. In patients with higher Pitt bacteremia score (≥4), mortality was significantly higher with monotherapy compared with combination therapy (66.7% vs 27.8%). In patients with lower Pitt bacteremia score (≤3), mortality was similar between the two treatment groups (26.3% vs 23.1%). Conclusion Treatment with colistin plus meropenem improves survival in critically-ill patients with CRAB.
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Affiliation(s)
- So Yeon Park
- Department of Internal Medicine, Division of Infectious Disease, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hye Jin Si
- Department of Internal Medicine, Division of Infectious Disease, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Joong Sik Eom
- Department of Internal Medicine, Division of Infectious Disease, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Jin Seo Lee
- Department of Internal Medicine, Division of Infectious Disease, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
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13
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Choe YJ, Lee HJ, Choi EH. Risk Factors for Mortality in Children with Acinetobacter baumannii Bacteremia in South Korea: The Role of Carbapenem Resistance. Microb Drug Resist 2019; 25:1210-1218. [PMID: 31120349 DOI: 10.1089/mdr.2018.0465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: Acinetobacter baumannii has become an important nosocomial pathogen that causes invasive infections. We conducted a retrospective study to evaluate the risk factors for mortality due to A. baumannii bacteremia in children. Materials and Methods: We reviewed data from Seoul National University Children's Hospital from 2002 to 2013 for children with A. baumannii bacteremia, including age, gender, underlying disease, associated site of infection, duration of hospitalization, presence of neutropenia, and antibiotic susceptibility data. The outcome measures were the 7- and 30-day mortality rates. Results: Among 74 A. baumannii bacteremia cases, 35.1% were carbapenem nonsusceptible. Common comorbidities were malignancy or hematologic diseases (28.4%), followed by gastrointestinal/hepatobiliary diseases (21.6%). A total of 47.3% of patients had isolated bacteremia, and in 33.8% of patients, pneumonia accompanied bacteremia. The mortality rates were 18.9% at 7 days and 35.1% at 30 days. The significant associated factors for 30-day mortality were carbapenem nonsusceptibility (adjusted hazard ratio [aHR]: 1.28, 95% confidence interval [CI]: 1.10-11.82, p = 0.034), neutropenia (aHR: 1.68, 95% CI: 1.60-18.03, p = 0.007), and prior intensive care unit (ICU) admission (aHR: 1.15, 95% CI: 1.03-9.73, p = 0.045). The mortality rate among neutropenic patients with inappropriate empirical antibiotics was higher than that among patients with appropriate empirical antibiotics (90.1% vs. 33.3%, p = 0.031). Conclusions: We identified carbapenem nonsusceptibility, neutropenia, and prolonged ICU stay as independent risk factors for mortality due to A. baumannii bacteremia in children. An early administration of appropriate antibiotics should be enacted, especially in patients with neutropenia.
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Affiliation(s)
- Young June Choe
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Hoan Jong Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
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14
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Peters L, Olson L, Khu DTK, Linnros S, Le NK, Hanberger H, Hoang NTB, Tran DM, Larsson M. Multiple antibiotic resistance as a risk factor for mortality and prolonged hospital stay: A cohort study among neonatal intensive care patients with hospital-acquired infections caused by gram-negative bacteria in Vietnam. PLoS One 2019; 14:e0215666. [PMID: 31067232 PMCID: PMC6505890 DOI: 10.1371/journal.pone.0215666] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 04/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Antibiotic resistance (ABR) is an increasing burden for global health. The prevalence of ABR in Southeast Asia is among the highest worldwide, especially in relation to hospital-acquired infections (HAI) in intensive care units (ICU). However, little is known about morbidity and mortality attributable to ABR in neonates. AIM This study aimed to assess mortality and the length of hospitalization attributable to ABR in gram-negative bacteria (GNB) causing HAI in a Vietnamese neonatal ICU (NICU). METHODS We conducted a prospective cohort study (n = 296) in a NICU in Hanoi, Vietnam, from March 2016 to October 2017. Patients isolated with HAI caused by GNB were included. The exposure was resistance to multiple antibiotic classes, the two outcomes were mortality and length of hospital stay (LOS). Data were analysed using two regression models, controlling for confounders and effect modifiers such as co-morbidities, time at risk, severity of illness, sex, age, and birthweight. RESULTS The overall case fatality rate was 44.3% and the 30 days mortality rate after infection was 31.8%. For every additional resistance to an antibiotic class, the odds of a fatal outcome increased by 27% and LOS increased by 2.1 days. These results were statistically significant (p < 0.05). CONCLUSION ABR was identified as a significant risk factor for adverse outcomes in neonates with HAI. These findings are generally in line with previous research in children and adults. However, heterogeneous study designs, the neglect of important confounders and varying definitions of ABR impair the validity, reliability, and comparability of results.
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Affiliation(s)
- Lynn Peters
- Global Health program, Karolinska Institutet, Stockholm, Sweden
| | - Linus Olson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Training and Research Academic Collaboration Sweden-Vietnam, Karolinska Institutet, Stockholm, Sweden
| | - Dung T. K. Khu
- Training and Research Academic Collaboration Sweden-Vietnam, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Sofia Linnros
- Global Health program, Karolinska Institutet, Stockholm, Sweden
| | - Ngai K. Le
- Training and Research Academic Collaboration Sweden-Vietnam, Karolinska Institutet, Stockholm, Sweden
- Department of Microbiology, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Håkan Hanberger
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Ngoc T. B. Hoang
- Department of Microbiology, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Dien M. Tran
- Research Institute for Child Health, Hanoi, Vietnam
- Department of Surgery, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Mattias Larsson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Training and Research Academic Collaboration Sweden-Vietnam, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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15
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Uwingabiye J, Lemnouer A, Baidoo S, Frikh M, Kasouati J, Maleb A, Benlahlou Y, Bssaibis F, Mbayo A, Doghmi N, Abouelalaa K, Baite A, Ibrahimi A, Elouennass M. Intensive care unit-acquired Acinetobacter baumannii infections in a Moroccan teaching hospital: epidemiology, risk factors and outcome. Germs 2017; 7:193-205. [PMID: 29264357 DOI: 10.18683/germs.2017.1126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/25/2017] [Accepted: 12/01/2017] [Indexed: 01/16/2023]
Abstract
Introduction The objective of this study was to examine the epidemiology, risk factors and outcome associated with Acinetobacter baumannii infections in the intensive care units (ICUs) in a Moroccan teaching hospital. Methods This is a matched case-control study conducted as a joint collaboration between the clinical Bacteriology department and the two ICUs of Mohammed V Military Teaching Hospital from January 2015 to July 2016. Results Among 964 patients hospitalized in the ICUs, 81 (8.4%) developed A. baumannii infections. Multivariate logistic regression analysis identified the following independent risk factors for ICU-acquired A. baumannii infections: ICU stay ≥14 days (odds ratio (OR)=6.4), prior use of central venous catheters (OR=18), prior use of mechanical ventilation (OR=9.5), duration of invasive procedures ≥7 days (OR=7.8), previous exposure to imipenem (OR=9.1), previous exposure to amikacin (OR=5.2), previous exposure to antibiotic polytherapy (OR=11.8) and previous exposure to corticotherapy (OR=5). On the other hand, the admission for post-operative care was identified as a protective factor. The crude mortality in patients with A. baumannii infection was 74.1%. Multivariate analysis showed that septic shock (OR=19.2) and older age (≥65 years) (OR=4.9) were significantly associated to mortality risk in patients with A. baumannii infection. Conclusion Our results show that shortening the ICU stay, rational use of medical devices and optimizing antimicrobial therapy could reduce the incidence of these infections. Elderly patients and those with septic shock have a poor prognosis. These findings highlight the need for focusing on the high-risk patients to prevent these infections and improve clinical outcome.
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Affiliation(s)
- Jean Uwingabiye
- PharmD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Abdelhay Lemnouer
- MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Sabina Baidoo
- PharmD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Mohammed Frikh
- MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Jalal Kasouati
- MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Adil Maleb
- PharmD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Yassine Benlahlou
- PharmD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Fatna Bssaibis
- Msc, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Albert Mbayo
- MD, Department of Intensive Care Units, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Nawfal Doghmi
- MD, Department of Intensive Care Units, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Khalil Abouelalaa
- MD, Department of Intensive Care Units, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Abdelouahed Baite
- MD, Department of Intensive Care Units, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Azeddine Ibrahimi
- PhD, Medical Biotechnology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Mostafa Elouennass
- MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
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Bacteremic and non-bacteremic pneumonia caused by Acinetobacter baumannii in ICUs of South China: A Clinical and Microbiological Study. Sci Rep 2017; 7:15279. [PMID: 29127419 PMCID: PMC5681499 DOI: 10.1038/s41598-017-13148-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 09/19/2017] [Indexed: 11/20/2022] Open
Abstract
Acinetobacter baumannii has been a dreadful problem for ICU physicians for a long time. Bacteremic pneumonia (BP) caused by this organism has a higher mortality compared to other organisms. Between 2012 and 2015, 86 BP and 89 non-bacteremic pneumonia (NBP) patients from five ICUs were enrolled into the study. The 7-day and 14-day mortality rates were higher in BP patients than in NBP patients (P < 0.001). Procalcitonin elevation, high APACHEII score and recent surgery, were independently associated with BP episodes. Acute respiratory distress syndrome, coma, high APACHEII score and procalcitonin elevation, were independently associated with mortality in the BP group. Extensively drug-resistant isolates were detected in 34.9% of BP and 25.8% of NBP isolates. PFGE identified 12 and 9 genotypes in the BP and NBP isolates, respectively, with 6 genotypes shared by both groups. ST195 was the most prevalent type (40%), followed by ST457 (18.9%). The pandemic clonal complex 92 was predominant, accounting for 94.3% of the strains. For all studied periods, mortality remained higher in the BP than the NBP group. Disease severity was the main risk factor for high mortality in the BP group, and other factors related to mortality were infection, and not treatment or microbiology-related.
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Uwingabiye J, Frikh M, Lemnouer A, Bssaibis F, Belefquih B, Maleb A, Dahraoui S, Belyamani L, Bait A, Haimeur C, Louzi L, Ibrahimi A, Elouennass M. Acinetobacter infections prevalence and frequency of the antibiotics resistance: comparative study of intensive care units versus other hospital units. Pan Afr Med J 2016; 23:191. [PMID: 27347280 PMCID: PMC4907753 DOI: 10.11604/pamj.2016.23.191.7915] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 03/07/2016] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION This study aims to determine the Acinetobacter sp clinical isolates frequency and its antibiotic susceptibility pattern by comparing results obtained from the Intensive Care Units (ICUs) to that of other units at the Mohammed V Military Teaching Hospital in Rabat. METHODS This is a retrospective study over a 2-years period where we collected all clinical isolates of Acinetobacter sp obtained from samples for infection diagnosis performed on hospitalized patients between 2012 to 2014. RESULTS During the study period, 441 clinical and non-repetitive isolates of Acinetobacter sp were collected representing 6.94% of all bacterial clinical isolates (n = 6352) and 9.6% of Gram negative rods (n = 4569). More than a half of the isolates were from the ICUs and were obtained from 293 infected patients of which 65, 2% (191 cases) were males (sex ratio = 1.9) and the median age was 56 years (interquartile range: 42-68 years). Acinetobacter clinical isolates were obtained from respiratory samples (44.67%) followed by blood cultures (14.51%). The resistance to ciprofloxacin, ceftazidime, piperacillin / tazobactam, imipenem, amikacin, tobramycin, netilmicin, rifampicin and colistin was respectively 87%, 86%, 79%, 76%; 52%, 43%, 33% 32% and 1.7%. The difference in resistance between the ICUs and the other units was statistically significant (p <0.05) except for colistin, tetracycline and rifampicin. CONCLUSION This paper shows that solving the problem of prevalence and high rate of multidrug resistant Acinetobacter infection which represents a therapeutic impasse, requires the control of the hospital environment and optimizing hands hygiene and antibiotics use in the hospital.
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Affiliation(s)
- Jean Uwingabiye
- Service de Bactériologie, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc; Equipe de recherche: Épidémiologie et Résistance Bactérienne (ERB), Université Mohammed V, Faculté de Médecine et de Pharmacie, Rabat, Maroc
| | - Mohammed Frikh
- Service de Bactériologie, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc; Equipe de recherche: Épidémiologie et Résistance Bactérienne (ERB), Université Mohammed V, Faculté de Médecine et de Pharmacie, Rabat, Maroc
| | - Abdelhay Lemnouer
- Service de Bactériologie, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc; Equipe de recherche: Épidémiologie et Résistance Bactérienne (ERB), Université Mohammed V, Faculté de Médecine et de Pharmacie, Rabat, Maroc
| | - Fatna Bssaibis
- Service de Bactériologie, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc; Equipe de recherche: Épidémiologie et Résistance Bactérienne (ERB), Université Mohammed V, Faculté de Médecine et de Pharmacie, Rabat, Maroc
| | - Bouchra Belefquih
- Service de Bactériologie, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc; Equipe de recherche: Épidémiologie et Résistance Bactérienne (ERB), Université Mohammed V, Faculté de Médecine et de Pharmacie, Rabat, Maroc
| | - Adil Maleb
- Service de Bactériologie, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Souhail Dahraoui
- Service de Bactériologie, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc; Equipe de recherche: Épidémiologie et Résistance Bactérienne (ERB), Université Mohammed V, Faculté de Médecine et de Pharmacie, Rabat, Maroc
| | - Lahcen Belyamani
- Service des Urgences, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Abdelouahed Bait
- Services des Réanimations, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Charki Haimeur
- Services des Réanimations, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Lhoussain Louzi
- Equipe de recherche: Épidémiologie et Résistance Bactérienne (ERB), Université Mohammed V, Faculté de Médecine et de Pharmacie, Rabat, Maroc
| | - Azeddine Ibrahimi
- Equipe de recherche: Épidémiologie et Résistance Bactérienne (ERB), Université Mohammed V, Faculté de Médecine et de Pharmacie, Rabat, Maroc; Laboratoire de Biotechnologie, Université Mohammed V, Faculté de Médecine et de Pharmacie, Rabat, Maroc
| | - Mostafa Elouennass
- Service de Bactériologie, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc; Equipe de recherche: Épidémiologie et Résistance Bactérienne (ERB), Université Mohammed V, Faculté de Médecine et de Pharmacie, Rabat, Maroc
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Walther BA, Boëte C, Binot A, By Y, Cappelle J, Carrique-Mas J, Chou M, Furey N, Kim S, Lajaunie C, Lek S, Méral P, Neang M, Tan BH, Walton C, Morand S. Biodiversity and health: Lessons and recommendations from an interdisciplinary conference to advise Southeast Asian research, society and policy. INFECTION GENETICS AND EVOLUTION 2016; 40:29-46. [PMID: 26903421 DOI: 10.1016/j.meegid.2016.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 01/01/2023]
Abstract
Southeast Asia is an economic, biodiverse, cultural and disease hotspot. Due to rapid socio-economic and environmental changes, the role of biodiversity and ecosystems for human health ought to be examined and communicated to decision-makers and the public. We therefore summarized the lessons and recommendations from an interdisciplinary conference convened in Cambodia in 2014 to advise Southeast Asian societies on current research efforts, future research needs, and to provide suggestions for improved education, training and science-policy interactions. First, we reviewed several examples of the important role of ecosystems as 'sentinels' in the sense that potentially harmful developments for human health become first apparent in ecosystem components. Other ecosystem services which also benefit human well-being are briefly summarized. Second, we summarized the recommendations of the conference's roundtable discussions and added recent developments in the science-policy interface. The recommendations were organized along five themes: Ethical and legal considerations; implementation of the One Health approach; education, training, and capacity building; future research priorities; and potential science-policy interactions. While the role of biodiversity for human health needs further research, especially for zoonoses and emerging diseases, many direct and indirect benefits to human health are already apparent, but have yet to filter down to the science-policy interface in order to influence legislation and enforcement. Therefore, efforts to strengthen the interface in Southeast Asia should become a high priority in order to strengthen the health and resilience of Southeast Asian societies.
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Affiliation(s)
- Bruno Andreas Walther
- Master Program in Global Health and Development, College of Public Health and Nutrition, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan, R.O.C.
| | - Christophe Boëte
- UMR_D 190 Unité des Virus Emergents Aix-Marseille Université - Institut de Recherche pour le Développement - Ecole des Hautes Etudes en Santé Publique, 27 Bd Jean Moulin, 13005, Marseille cedex 05, France
| | - Aurélie Binot
- CIRAD-ES, UPR AGIRs, F-34398, Montpellier, France; Kasetsart University, Faculty of Veterinary Medicine, Bangkok, Thailand
| | - Youlet By
- Fondation Mérieux, 73 Boulevard Monivong, Phnom Penh, Cambodia
| | - Julien Cappelle
- CIRAD-ES, UPR AGIRs, F-34398, Montpellier, France; Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, BP, 983, Phnom Penh, Cambodia
| | - Juan Carrique-Mas
- Hospital for Tropical Diseases, Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Old Road Campus Oxford, OX3 7BN, United Kingdom
| | - Monidarin Chou
- University of Health Sciences, 73 Boulevard Monivong, Phnom Penh, Cambodia
| | - Neil Furey
- Fauna & Flora International, PO Box 1380, No. 19, Street 360, Boeng Keng Kang 1, Phnom Penh, Cambodia, 12000
| | - Sothea Kim
- University of Health Sciences, 73 Boulevard Monivong, Phnom Penh, Cambodia
| | - Claire Lajaunie
- UMR URMITE, U1095 INSERM - Aix-Marseille Université - Institut de Recherche pour le Développement - CNRS, 27 Bd Jean Moulin, 13385, Marseille cedex 05, France
| | - Sovan Lek
- Université de Toulouse, Lab. Evolution & Diversité Biologique, UMR 5174 CNRS - Université Paul Sabatier, 118 route de Narbonne, 31062, Toulouse cedex 9, France
| | - Philippe Méral
- UMR GRED (IRD - University Paul Valery Montpellier 3), 911 av. agropolis, BP, 64501 34 394 Montpellier Cedex 5, France; Ecoland Research Centre - Royal University of Agriculture (RUA) Faculty of Agricultural Economics and Rural Development Dangkor district, Phnom Penh, Cambodia
| | - Malyne Neang
- Ecoland Research Centre - Royal University of Agriculture (RUA) Faculty of Agricultural Economics and Rural Development Dangkor district, Phnom Penh, Cambodia
| | - Boon-Huan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
| | - Catherine Walton
- Faculty of Life Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Serge Morand
- CIRAD-ES, UPR AGIRs, F-34398, Montpellier, France; CNRS, Centre d'Infectiologie Christophe Mérieux du Laos, Vientiane, Laos; Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Molecular survey of the head louse Pediculus humanus capitis in Thailand and its potential role for transmitting Acinetobacter spp. Parasit Vectors 2015; 8:127. [PMID: 25889008 PMCID: PMC4347573 DOI: 10.1186/s13071-015-0742-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Head louse infestation, which is caused by Pediculus humanus capitis, occurs throughout the world. With the advent of molecular techniques, head lice have been classified into three clades. Recent reports have demonstrated that pathogenic organisms could be found in head lice. Head lice and their pathogenic bacteria in Thailand have never been investigated. In this study, we determined the genetic diversity of head lice collected from various areas of Thailand and demonstrated the presence of Acinetobacter spp. in head lice. METHODS Total DNA was extracted from 275 head louse samples that were collected from several geographic regions of Thailand. PCR was used to amplify the head louse COI gene and for detection of Bartonella spp. and Acinetobacter spp. The amplified PCR amplicons were cloned and sequenced. The DNA sequences were analyzed via the neighbor-joining method using Kimura's 2-parameter model. RESULTS The phylogenetic tree based on the COI gene revealed that head lice in Thailand are clearly classified into two clades (A and C). Bartonella spp. was not detected in all the samples, whereas Acinetobacter spp. was detected in 10 samples (3.62%), which consisted of A. baumannii (1.45%), A. radioresistens (1.45%), and A. schindleri (0.72%). The relationship of Acinetobacter spp. and the head lice clades showed that Acinetobacter spp. was found in clade A and C. CONCLUSIONS Head lice in Thailand are classified into clade A and B based on the COI gene sequences. Pathogenic Acinetobacter spp. was detected in both clades. The data obtained from the study might assist in the development of effective strategies for head lice control in the future. Detection of pathogenic bacteria in head lice could raise awareness of head lice as a source of nosocomial bacterial infections.
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Abstract
BACKGROUND Pediatric bacterial bloodstream infections (BSIs) are a major cause of morbidity and mortality worldwide. Epidemiological data from resource-limited settings in southeast Asia, such as Cambodia, are sparse but have important implications for treatment and public health strategies. METHODS We retrospectively investigated BSI in children at a pediatric hospital and its satellite clinic in Siem Reap, Cambodia, from January 1, 2007, to July 31, 2011. The range of bacterial pathogens and their antimicrobial susceptibility patterns were analyzed in conjunction with demographic, clinical and outcome data. RESULTS Of 7682 blood cultures with results (99.9% of cultures taken), 606 (7.9%) episodes of BSI were identified in 588 children. The incidence of BSI increased from 14 to 50/1000 admissions (P < 0.001); this was associated with an increased sampling rate. Most BSI were community acquired (89.1%). Common pathogens included Salmonella Typhi (22.8% of all isolates), Staphylococcus aureus (12.2%), Streptococcus pneumoniae (10.0%), Klebsiella pneumoniae (6.4%) and Escherichia coli (6.3%). 21.5% of BSI were caused by a diverse group of uncommon organisms, the majority of which were environmental Gram-negative species. No Listeria monocytogenes or Group B streptococcal BSI were identified. Antimicrobial resistance, particularly among the Enterobacteriaceae, was common. Overall mortality was substantial (19.0%), higher in neonates (36.9%) and independently associated with meningitis/meningoencephalitis and K. pneumoniae infection. CONCLUSIONS BSI is a common problem in Cambodian children attending hospital and associated with significant mortality. Further studies are needed to clarify the epidemiology of neonatal sepsis, the contribution of atypical organisms and the epidemiology of pneumococcal disease before the introduction of vaccine.
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