Acinetobacter baumannii isolates in a tertiary care hospital: Antimicrobial resistance and clinical significance

Yıl 2012, Cilt: 2 Sayı: 02, 57 - 63, 01.06.2012

Namita Jaggi Pushpa Sissodia Lalit Sharma

https://doi.org/10.5799/ahinjs.02.2012.02.0043

Cited By: 10

Öz

Objectives: To carry out a retrospective study on Acinetobacter baumannii isolates from various clinical samples in a tertiary care hospital in India and analyze its epidemiology, antibiotic susceptibility patterns, pathogenic potential and nosocomial status. Materials and methods: The clinical specimens over a period of 14 months from December 2008 to January 2010 were analyzed and the A.baumannii isolates obtained by an automated identification system (Vitek 2 Compact) were segregated for further study. Their antibiograms were studied and a clinical correlation was made to assess their pathogenic status and mode of acquisition. Further, the nosocomial infections acquired during this period were studied and the contribution made by A.baumannii was calculated to assess its nosocomial status. Results: A.baumannii was isolated in 155 samples out of 1632 gram negative isolates (9.4% prevalence) from the entire hospital. Maximum isolates were from respiratory secretions (57.4%) followed by blood (23.8%). Prevalence of A.baumannii rose to 22.7% (119 out of 525) in intensive care unit (ICU) and 65 isolates (54.6%) proved to be pathogenic. A.baumannii contributed to 30.4% ventilator associated pneumonia, 35.2% Catheter Associated Blood Stream Infections, 12.5% Surgical Site Infections and 2.94% Catheter Associated Urinary Tract Infections. Overall resistance of A.baumannii towards carbapenems was 90% from all hospital isolates. ICU isolates showed higher resistance (93.2%) as compared to Inpatient Department (82.7%) and Out-patient Department (57.1%). Conclusion: In this study, A.baumannii isolates showed a pathogenic potential of around 54.6% and a majority were found to be carbapenem resistant. We must be cognizant of the fact that all A.baumannii isolations doesn\'t necessarily mean infection and antibiotics should only be given in clinically proven infections.

Anahtar Kelimeler

-

Acinetobacter baumannii isolates in a tertiary care hospital: Antimicrobial resistance and clinical significance

Öz

Anahtar Kelimeler

-

Kaynakça

• 1. Munoz-Price LS, Robert A Weinstein. Acinetobacter Infection: Current concepts. N Engl J Med 2008; 358:1271-1281.
• 2. Young LS, Sabel AL, Price CS. Epidemiologic, clinical, and economic evaluation of an outbreak of clonal multidrug-resistant Acinetobacter baumannii infection in a surgical intensive care unit. Infect Control Hosp Epidemiol 2007; 28:1247- 1254.
• 3. Towner KJ. Acinetobacter: An old friend, but a new enemy. J Hosp Infect 2009; 73:355-363.
• 4. Jose M. Cisneros, Maria J. R, Jeronimo P, et al. Bacteremia Due to Acinetobacter baumannii: Epidemiology, Clinical Findings, and Prognostic Features. Clin Infect Dis 1996; 22:1026-1032.
• 5. Lolans K, Rice TW, Munoz-Price LS et al. Multicity outbreak of carbapenem resistant Acinetobacter baumannii isolates producing the carbapenemase OXA-40. Antimicrob Agents Chemother 2006; 50:2941-2945.
• 6. Urban C, Segal-Maurer S, Rahal JJ. Considerations in control and treatment of nosocomial infections due to multidrug resistant Acinetobacter baumannii. Clin Infect Dis 2003; 36:1268-1274.
• 7. Clinical and Laboratory Standard Institute. Performance standards for antimicrobial susceptibility Testing: Seventeenth informational supplement. Wayne, PA, USA: CLSI 2007, M100-S17;27(1).
• 8. Centers for Disease control and prevention guidelines for nosocomial infections. Available at: http://www.cdc.gov/ncidod/ dhqp/hicpac_pubs.html. Accessed December 3, 2009.
• 9. H. Siau, KY Yuen, SSY Wong. The epidemiology of Acinetobacter infections in Hongkong, J Med Microbiol 1996; 44:340-347.
• 10. Pederson MM, Marso E, Picket MJ. Non fermentative bacilli associated with man III pathogenicity and antibiotic susceptibility. Am J Clin Pathol 1970; 54:178-192.
• 11. Villers D, Espase E, Coste-Burel M, et al. Nosocomial Acinetobacter baumannii infections: Microbiological and clinical epidemiology. Ann Intern Med 1998; 129:182-189.
• 12. Suri A, Mahapatra AK, Kapil A. et al Acinetobacter infection in neurosurgical intensive care patients. Natl Med J India 2000; 13:296-300.
• 13. Glow RH, Moellering RC, Kunz LJ. Infections with Acinetobacter calcoaceticus (Herellea vaginicola): Clinical and laboratory studies. Medicine 1997;56:79-97.
• 14. Tankovic J, Legrard P, Gatines GD et al. Characterisation of a hospital outbreak of Imipenam resistant Acinetobacter baumannii by phenotypic and genotypic typing methods. J Clin Microbiol 1994; 32(ii):2677-2681.
• 15. Lahiri KK, Mani NS, Purai SS. Acinetobacter spp as Nosocomial Pathogen: Clinical Significance and Antimicrobial Sensitivity. MJAFI 2004; 60:7-10.
• 16. Sengupta S, Kumar P, Ciraj A M, et al. Acinetobacter baumannii- An emerging nosocomial pathogen in the burns unit Manipal, India. Burns 2001; 27:140-144.
• 17. Torres, A, Aznar, R, Gatell, JM, et al. Incidence, risk and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990;142:523-528.
• 18. Zakuan Z D, Azian H, Mahamarowi O, et al. The prevalence and risk factors of nosocomial Acinetobacter blood-stream infections in tertiary teaching hospital in North Eastern Malaysia. Trop Biomed 2009;26:123-129.
• 19. Jones M, Donegan N, Saiines S, et al. Acinetobacter (ACBA) in sternal surgical site infections (SSI) after cardiac surgery: Case control to determine significance and outcome. Am J Infect Control 2005; 33:169-170.
• 20. Knam Soo Ko, Ji Yoeun Suh, Ki Tae Kwon, et al. High rates of resistance to colistin and Polymixin B in subgroups of Acinetobacter baumannii isolates from Korea. J Antimicrob Chemother 2007; 60:1163-1167.
• 21. Gaur A, Garg A, Prakash P, Anupurba S, and Mohapatra T M. Observations on Carbapenem Resistance by Minimum Inhibitory Concentration in Nosocomial Isolates of Acinetobacter species: An Experience at a Tertiary Care Hospital in North India. J Health Popul Nutr 2008; 26: 183-188.
• 22. Yau W, Owen RJ, Poudyal A, et al. Colistin heteroresistance in multidrug-resistant Acinetobacter baumannii clinical isolates from the western pacific region in the SENTRY antimicrobial surveillance programme. J Infect 2009; 58:138-144.
• 23. Navon-Venezia S, Leavitt A, Carmeli Y. High tigecycline resistance in multidrug resistant Acinetobacter baumannii. J Antimicrob Chemother 2007; 59:772-774.
• 24. Behera B, Das A, Mathur P, et al. Tigecycline susceptibility report from an Indian tertiary care hospital. Indian J Med Res 2009; 129:446-450.