PREVALENCE OF CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII (CRAB) IN MEDICAL AND SURGICAL INTENSIVE CARE UNITS (ICUS) OF JPMC, KARACHI

2019 ◽  
Author(s):  
Rabia Arshad
Keyword(s):  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Acinetobacter Baumannii ◽  
Intensive Care Units ◽  
Carbapenem Resistance ◽  
Chronic Obstructive ◽  
Surgical Intensive Care ◽  
Carbapenem Resistant ◽  
Number Of Patients ◽  
Increased Risk

Background: Antimicrobial resistance is one of the research priorities of health organizations due to increased risk of morbidity and mortality. Outbreaks of nosocomial infections caused by carbapenem-resistant Acinetobacter Baumannii (CRAB) strains are at rise worldwide. Antimicrobial resistance to carbapenems reduces clinical therapeutic choices and frequently led to treatment failure. The aim of our study was to determine the prevalence of carbapenem resistance in A. baumannii isolated from patients in intensive care units (ICUs). Methods: This cross-sectional study was carried out in the Department of Microbiology, Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Centre (JPMC), Karachi, from December 2016 to November 2017. Total 63 non-repetitive A. baumannii were collected from the patients’ specimens, admitted to medical and surgical ICUs and wards of JPMC, Karachi. The bacterial isolates were processed according to standard microbiological procedures to observe for carbapenem resistance. SPSS 21 was used for data analysis. Results: Out of the 63 patients, 40 (63.5%) were male. The age of the patient ranged from 15-85 year, with average of 43 year. 34.9% patients had been hospitalized for 3 days. Chronic obstructive pulmonary disease was present in highest number with average of 58.7% for morbidity. Number of patients on mechanical ventilation was highest (65.1%). All isolates were susceptible to colistin. The resistance to ampicillin-sulbactam, ceftazidime, ciprofloxacin, amikacin, piperacillin- tazobactam and meropenem was 82.5%, 81%, 100%, 87.3%, 82.5% and 82% respectively. Out of 82% CRAB, 77% were obtained from ICUs. Conclusion: This study has revealed the high rate of carbapenem resistance in A. baumannii isolates in ICUs thus leaving behind limited therapeutic options.

scholarly journals Emergence of carbapenem-resistant Acinetobacter baumannii as the major cause of ventilator-associated pneumonia in intensive care unit patients at an infectious disease hospital in southern Vietnam

2014 ◽  
Vol 63 (10) ◽  
pp. 1386-1394 ◽  
Author(s):  
Nguyen Thi Khanh Nhu ◽  
Nguyen Phu Huong Lan ◽  
James I. Campbell ◽  
Christopher M. Parry ◽  
Corinne Thompson ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Acinetobacter Baumannii ◽  
Antimicrobial Susceptibility ◽  
Ventilator Associated Pneumonia ◽  
Infectious Disease Hospital ◽  
Southern Vietnam ◽  
Carbapenem Resistant ◽  
Disease Hospital

Ventilator-associated pneumonia (VAP) is a serious healthcare-associated infection that affects up to 30 % of intubated and mechanically ventilated patients in intensive care units (ICUs) worldwide. The bacterial aetiology and corresponding antimicrobial susceptibility of VAP is highly variable, and can differ between countries, national provinces and even between different wards in the same hospital. We aimed to understand and document changes in the causative agents of VAP and their antimicrobial susceptibility profiles retrospectively over an 11 year period in a major infectious disease hospital in southern Vietnam. Our analysis outlined a significant shift from Pseudomonas aeruginosa to Acinetobacter spp. as the most prevalent bacteria isolated from quantitative tracheal aspirates in patients with VAP in this setting. Antimicrobial resistance was common across all bacterial species and we found a marked proportional annual increase in carbapenem-resistant Acinetobacter spp. over a 3 year period from 2008 (annual trend; odds ratio 1.656, P = 0.010). We further investigated the possible emergence of a carbapenem-resistant Acinetobacter baumannii clone by multiple-locus variable number tandem repeat analysis, finding a bla OXA-23-positive strain that was associated with an upsurge in the isolation of this pathogen. We additionally identified a single bla NDM-1-positive A. baumannii isolate. This work highlights the emergence of a carbapenem-resistant clone of A. baumannii and a worrying trend of antimicrobial resistance in the ICU of the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam.

scholarly journals The epidemiology of carbapenem resistance in Acinetobacter baumannii complex in Germany (2014–2018): an analysis of data from the national Antimicrobial Resistance Surveillance system

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Dunja Said ◽  
Niklas Willrich ◽  
Olaniyi Ayobami ◽  
Ines Noll ◽  
Tim Eckmanns ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Acinetobacter Baumannii ◽  
Respiratory Infections ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Infection Prevention And Control ◽  
Antimicrobial Resistance Surveillance ◽  
Carbapenem Resistant ◽  
Acinetobacter Baumannii Complex ◽  
Epidemiological Trends

Abstract Background Carbapenem-resistant Acinetobacter baumannii complex (CRABC) has globally emerged as a serious public health challenge. This study aimed to describe epidemiological trends and risk factors of carbapenem resistance in A. baumannii complex isolates in Germany between 2014 and 2018. Methods We analysed 43,948 clinical A. baumannii complex isolates using 2014 to 2018 data from the German Antimicrobial Resistance Surveillance system. We applied descriptive statistics and uni- and multivariable regression analyses to investigate carbapenem resistance in A. baumannii complex isolates. Results The proportion of carbapenem resistance in clinical A. baumannii complex isolates declined from 7.6% (95% confidence interval [95% CI] 4.4–12.7%) in 2014 to 3.5% (95% CI 2.5–4.7%) in 2018 (adjusted OR [aOR] 0.85 [95% CI 0.79–0.93, p ≤ 0.001]). Higher mean CRABC proportions for 2014 to 2018 were observed in secondary care hospitals (4.9% [95% CI 3.2–7.5%], aOR 3.6 [95% CI 2.4–5.3, p ≤ 0.001]) and tertiary care hospitals (5.9% [95% CI 3.0–11.2%], aOR 5.4 [95% CI 2.9–10.0, p ≤ 0.001) compared to outpatient clinics (1.3% [95% CI 1.1–1.6%]). CRABC proportions in hospitals varied between German regions and ranged between 2.4% (95% CI 1.6–3.5%) in the Southeast and 8.8% (95% CI 4.2–17.3%) in the Northwest. Lower CRABC proportions were observed in younger patients (< 1 year: 0.6% [95% CI 0.2–1.3%]; 1–19 years: 1.3% [95% CI 0.7–2.5%]) than adults (20–39 years: 7.7% [95% CI 4.4–13.0%]; 40–59 years: 6.2% [4.2–8.9%]; 60–79 years: 5.8% [95% CI 4.0–8.3%]). In the 20–39 year old patient age group, CRABC proportions were significantly higher for men than for women (14.6% [95% CI 8.6–23.6%] vs. 2.5% [95% CI 1.3–4.5%]). A. baumannii complex isolates from lower respiratory infections were more likely to be carbapenem-resistant than isolates from upper respiratory infections (11.4% [95% CI 7.9–16.2%] vs. 4.0% [95% CI 2.7–6.0%]; adjusted OR: 1.5 [95% CI 1.2–1.9, p ≤ 0.001]). Conclusions In contrast to many other regions worldwide, carbapenem resistance proportions among clinical A. baumannii complex isolates are relatively low in Germany and have declined in the last few years. Ongoing efforts in antibiotic stewardship and infection prevention and control are needed to prevent the spread of carbapenem-resistant A. baumannii complex in Germany.

scholarly journals Hospital infections in neonatal intensive care units

2005 ◽  
Vol 58 (9-10) ◽  
pp. 490-493
Author(s):  
Jasna Djurisic ◽  
Ljiljana Markovic-Denic ◽  
Slobodanka Ilic ◽  
Ruzdi Ramadani
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Hospital Infections ◽  
Hospital Acquired Infections ◽  
Number Of Patients ◽  
Increased Risk ◽  
Hospital Acquired ◽  
Epidemiological Characteristics

Introduction Sick newborn babies in the neonatal intensive care units (NICU) are al increased risk for hospital-acquired infections (HI). The aim of our study was to determine the incidence and localization of neonatal hospital infections in NICU. Material and methods A prospective, six-month study was carried out in a NICU. All patients hospitalized in NICU longer then 48 hours were examined according to their basic descriptive-epidemiological characteristics and the incidence of all hospital-acquired infections (diagnosed using CDC criteria) were accounted for. Results The incidence of patients with HI was 46.1% while the incidence of HI was 57.2%. On the basis of patients' records in the NICU, the incidence of HI was 43.9 per WOO patient- hospital days. Patients with HI were hospitalized significantly longer in NICU than patients without HI (t=9.2 DF=267 p<0.001). In terms of localization of HI, a large number of patients had pneumonia - 74.7% (115/154), followed by sepsis (37/154), while two had meningitis. Conclusion This study suggests that it is necessary to maintain continuous surveillance of HI in NICU, as well as infection control measures, which are also very beneficial.

scholarly journals Factors Related to Mortality in Carbapenem Resistant Acinetobacter baumannii Infections in Intensive Care Units: A Prospective Observational Study

2020 ◽  
Vol 25 (3) ◽  
pp. 391-400
Author(s):  
Arzu Nazlı Zeka ◽  
Bilgin Arda ◽  
Oğuz Reşat Sipahi ◽  
Mehmet Uyar
Keyword(s):  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Intensive Care Units ◽  
Antibiotic Treatment ◽  
Sofa Score ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Antimicrobial Treatment ◽  
Related Factor ◽  
Carbapenem Resistant

Introduction: Management of carbapenem resistant Acinetobacter baumannii infections in intensive care units is challenging because of few treatment options and poor outcomes. In order to contribute to patients’ survival, the factors related to mortality in these infections were evaluated in this study. Materials and Methods: In the 6-month study period, we included 60 patients with carbapenem resistant A. baumannii infections (45 ventilator associated pneumonia and 15 bacteremia) in two intensive care units of our hospital. We collected data of the patients prospectively. We noted demographic features of patients, Acute Physiology and Chronic Health Evaluation (APACHE II) , Sequential Organ Failure Assessment (SOFA), Clinical Pulmonary Infection Score (CPIS), Acute Kidney Injury (AKIN) scores, antibiotic treatments, clinical and microbiological outputs, and mortality rates during treatment and on the 30th day. Results: We observed that infections appeared at mean 11th day of the patients’ stay in the intensive care unit. Carbapenem resistant A. baumannii isolates were highly resistant to antibiotics except colistin. Only 9% of the patients had proper empirical treatment. Twenty five percent of the patients were dead before having a specific antibiotic treatment. Crude mortality rate was 66.7%, and 30th day mortality was 71.7%. The patients who had colistin and tigecycline combination had higher survival rates, but it was statistically insignificant. In univariate analysis high SOFA score (p= 0.0001), high procalcitonin level (p= 0.01), septic shock (p= 0.005), renal insufficiency (p= 0.005), rheumatological disease (p= 0.03) were related to higher mortality. We detected high SOFA score on the first day of infection as the only mortality related factor in multivariate analysis (p= 0.012). The patients who had higher mortality were those with delayed (> 3 days) proper antimicrobial treatment (p= 0.03). Conclusion: In our study, the high SOFA score on the first day of infection in intensive care units was found as a risk factor for mortality. We suggest that prompt administration of the proper antibiotic treatment to the patients who have risk factors for carbapenem-resistant A. baumannii infection can contribute to survival.

scholarly journals Phenotypic and Genotypic Evaluation of Antibiotic Resistance of Acinetobacter baumannii Bacteria Isolated from Surgical ICU Patients in Pakistan

2021 ◽  
Vol 14 (4) ◽  
Author(s):  
Nureen Zahra ◽  
Basit Zeshan ◽  
Muhammad Mubeen Ali Qadri ◽  
Musarat Ishaq ◽  
Muhammad Afzal ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Acinetobacter Baumannii ◽  
Pcr Amplification ◽  
Carbapenem Resistance ◽  
Surgical Intensive Care ◽  
Phenotypic Resistance ◽  
Carbapenem Resistant ◽  
Resistance Patterns ◽  
Surgical Icus ◽  
Surgical Icu

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a significant nosocomial pathogen, causing serious threats concerning community-wide outbreaks globally, as well as in Pakistan. Antimicrobial resistance in A. baumannii is increasing day by day. Objectives: The study aimed to find out the antibiotic resistance (AMR) patterns and evaluate the AMR genes in clinical isolates from patients admitted to the surgical Intensive Care units (ICUs) at different hospitals in Lahore, Pakistan. Methods: A total of 593 clinical specimens were collected from patients admitted to the surgical ICUs of three different local hospitals in Lahore, Pakistan. From these samples, a total of 90 A. baumannii isolates were identified and further investigated to observe phenotypic resistance patterns and detect carbapenemases resistance genes. Results: The results showed that phenotypic resistance against amikacin was 27.2%, ceftriaxone 100%, ceftazidime 27.2%, cefepime 63.3%, ciprofloxacin and co-trimoxazole 100%, gentamicin 40%, imipenem 22.2%, meropenem 21.1%, piperacillin-tazobactam 27.2%, tigecycline 27.2%, and tetracycline 63.3%. All A. baumannii isolates were found to be sensitive to colistin (CT), polymixin-B (PB), and tobramycin (TOB). The PCR amplification of carbapenemases genes revealed the prevalence of blaOXA-23, blaOXA-51, and blaOXA-40 in 73, 90, and 64.4% of the isolates, respectively, along with blaNDM1 (92.2%), blaVIM (40%), blaIMP (90%), ISAba1 (85.5%), sul1 (16.6%), sul2 (20%), armA (32.2%), and PER-1 (12%) while the blaOXA-24 and blaOXA-58 genes were not detected in the isolates. The sequence analysis of the blaOXA-23 and blaOXA-51 genes showed 98% and 95% similarity with previously reported sequences in the GenBank database. Conclusions: The present study indicated that the emergence of high carbapenem resistance in CRAB isolates has increased, which may pose serious limitations in the choice of drugs for nosocomial infections.

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