Defining the Risk Factors for the Evolution of Pan-Drug Resistance (PDR) Acinetobacter baumanni Infections in Intensive Care Units

Yıl 2023, , 416 - 420, 31.12.2023

Edip Bayrak , Mustafa Gökhan Gözel

https://doi.org/10.36516/jocass.1359576

Öz

ABSTRACT
Intorductıon:Acinetobacter baumannii is one important nosocomial pathogenes. Acinetobacter infections causes long in hospital stay, mortality and morbidity. The aim of this study is to define the risk factors of PDR A. baumannii caused health care related(HCR) infections.

Materyal and Methods:In the study of Cumhuriyet University Hospital between 01.01.201231.12.2013 is a case-control study was performed retrospectively. 49 PDR A. baumannii caused ventilator associated pneumonia and bacteraemia, 71 other bacteria caused ventilator associated pneumonia and bacteraemia patients were involved in this study. The PDR A. baumannii infection observed cases and the cases irrelevant to PDR A. baumannii infections are compared in terms of risk factors.

Result:As a result of the Univariate Analysis, it was found that DM, traumas, CCI>4, steroid use, hospitalization history in the last 3 months, and antibiotic use in the last 3 months were statistically and significantly higher in the PDR A. baumannii Group. Multivariate analysis was used to determine the risk factors with a p value of 0.1 and below by univariate analysis. In this respect, traumas (OR=93.32, p=0.011), steroid use (OR=21.09, p<0.001) and antibiotic use in the last 3 months. (OR=26.97, p=0.001) were determined as independent risk factors in the development of PDR A. baumannii VAP and bloodstream infection.

Dıscussıon:All risk factors for health care related PDR. Acinetobacter infections were modifiable. The control of these factors may decrease the ratio of PDR A. baumannii. In case of detection of PDR A. baumannii infection in hospitals, control measures should be applicated,hospital staff should be educated and inappropriate antibiotic use should be prohibited.

ÖZET
Giriş:Acinetobacter baumannii önemli nozokomiyal patojenlerden biridir.
Acinetobacter enfeksiyonları hastanede kalış süresinin uzamasına,mortalite ve morbiditeye neden olur. Bu çalışmanın amacı PDR A. baumannii nedenli sağlık bakımı ilişkili (SBİ) enfeksiyonlar için risk faktörlerinin belirlenmesidir.

Gereç ve yöntemler:Çalışma Cumhuriyet Üniversitesi Tıp Fakültesi Hastanesi’nde 01.01.201231.12.2013 tarihleri arasında retrospektif olarak gerçekleştirilmiş bir vaka-kontrol çalışmasıdır. Çalışmaya PDR A. baumannii ile oluşan 49 ventilatör ilişkili pnömoni ve bakteriyemi, 71 A. baumannii dışı etkenlerle oluşan ventilatör ilişkili pnömoni ve bakteriyemi hastası alınmıştır. PDR A. baumannii enfeksiyonu saptanan olgularla saptanmayan olgular risk faktörleri yönünden karşılaştırılmıştır.

Sonuç:Univariate analiz sonuçları sonucunda PDR A.baumannii grubunda DM, travma, CCI>4 olması, steroid kullanımı, son 3 ay hastanede yatış öyküsü ve son 3 ay antibiyotik kullanımı istatiksel anlamlı olarak daha yüksek olduğu bulundu.Univariate analiz ile p değeri 0.1 ve altında saptanan risk faktörleri bağımsız risk faktörlerinin belirlenmesi için multivariate analiz uygulandı.Buna göre travma (OR=93.32, p=0.011), steroid kullanımı (OR=21.09, p<0.001) ve son 3 ay antibiyotik kullanımı’nın (OR=26.97, p=0.001) PDR A.baumannii VİP ve kan dolaşımı infeksiyon gelişiminde bağımsız risk faktörleri olarak tespit edildi.

Tartışma:PDR Acinetobacter nedenli sağlık bakımı ilişkili enfeksiyonlarda çoğu risk faktörleri düzeltilebilir özelliktedir. Bu risk faktörlerinin kontrolü PDR.A. baumannii oranlarını düşürebilir. Hastanelerde PDR Acinetobacter enfeksiyonu tespit edilmesi durumunda rehberler eşliğinde kontrol önlemleri alınmalı, hastane personeli eğitilmeli ve uygunsuz antibiyotik kullanımının önüne geçilmelidir.

Anahtar Kelimeler

rısk factors, control precautıons, Acınetobacter baumannıı

Kaynakça

• 1.Liu Q,Li W, Feng Y, Tao C. Efficacy and safety of polymyxins for the treat-ment of Acinectobacter baumannii infection: a systematic review and meta-analysis. PloS one. 2014; 9(6): e98091. https://doi.org/10.1371/journal.pone.0098091
• 2.Kim UJ, Kim HK, An JH, et al. Update on the Epidemiology, Treatment, and Outcomes of Carbapenem-resistant Acinetobacter infections. Chonnam medical journal. 2014; 50(2): 37-44. https://doi.org/10.4068/cmj.2014.50.2.37
• 3.Gaynes R, Edwards JR, National Nosocomial Infections Surveillance S. Overview of nosocomial infections caused by gram-negative bacilli. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2005; 41(6): 848-54. https://doi.org/10.1086/432803
• 4.Wisplinghoff H, Edmond MB, Pfaller MA, et al. Nosocomial bloodstream in¬fections caused by Acinetobacter species in United States hospitals: clinical features, molecular epidemiology, and antimicrobial susceptibility. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2000; 31(3): 690-7. https://doi.org/10.1086/314040
• 5.Wisplinghoff H, Bischoff T, Tallent SM, et al. Nosocomial blood stream in-fections in US hospitals: analysis of 24,179 cases from a prospective nation wide surveillance study. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2004; 39(3): 309-17. https://doi.org/10.1086/421946
• 6.Falagas ME, Bliziotis IA, Siempos II. Attributable mortality of Acinetobacter baumannii infections in critically ill patients: a systematic review of matched cohort and case-control studies. Critical care. 2006; 10 (2): R48. https://doi.org/10.1186/cc4869
• 7.Zhang J, Yu W, Zhao L, et al. Status and characteristics of bacterial re-sistance in China [J]. Chinese Journal of clinical infectious diseases. 2016; 9(02): 118-28.
• 8.Jiang M, Liu L, Ma Y, et al. Molecular Epidemiology of Multi-Drug Resistant Acinetobacter baumannii Isolated in Shandong, China. Front Microbiol. 2016; 21(7): 1687-9. https://doi.org/10.3389/fmicb.2016.01687
• 9.Bouguenoun W, Bakour S, Bentorki AA, et al. Molecular epidemiology of environmental and clinical carbapenemase-producing Gram-negative bacilli from hospitals in Guelma, Algeria: Multiple genetic lineages and first report of OXA-48 in Enterobacter cloacae. J Glob Antimicrob Resist. 2016; 12(7): 135-40. https://doi.org/10.1016/j.jgar.2016.08.011
• 10.Sun LJ, Xue HL, Chen MH, et al. Surveillance of pathogenic bacteria and drug resistance of abdominal cavity infection in 2012-2014. Chinese Journal of integrative surgery. 2016; 13(01): 24-7.
• 11.Lee HY, Chen CL, Wu SR, et al. Risk factors and outcome analysis of Aci-netobacter baumannii complex bacteremia in critical patients. Crit Care Med. 2014; 42: 1081-8. https://doi.org/10.1097/CCM.0000000000000125
• 12.Liu CP, Shih SC, Wang NY, et al. Risk factors of mortality in patients with carbapenem resistant Acinetobacter baumannii bacteremia. Microbiol Im-munol Infect. 2016; 49: 934-40. https://doi.org/10.1016/j.jmii.2014.10.006
• 13.Liu Q, Li W, Du X, et al. Risk and prognostic factors for multidrugresistant Acinetobacter baumannii complex bacteremia: a retrospective study in a ter¬tiary hospital of west China. PloS One. 2015; 10: e0130701. https://doi.org/10.1371/journal.pone.0130701
• 14.Shih MJ, Lee NY, Lee HC, et al. Risk factors of multidrug resistance in nos¬ocomial bacteremia due to Acinetobacter baumannii: a case-control study. Microbiol Immunol Infect. 2008; 41: 118-23. 15.Gu Z, Han Y, Meng T, et al. Risk factors and clinical outcomes for patients with Acinetobacter baumannii bacteremia. Medicine. 2016; 95: e2943.16.
• 16.Nutman A, Glick R, Temkin E, et al. A case-control study to identify pre-dictors of 14-day mortality following carbapenem-resistant Acinetobacter baumannii bacteraemia. Clin Microbiol Infect. 2014; 20: O1028-34. https://doi.org/10.1111/1469-0691.12716
• 17.Eren F, Öngün G, Ural O, et al. Nöroloji yoğun bakım ünitesinde bir yıllık hastane enfeksiyonu oranları: Patojenik ve klinik değerlendirme. Türk Nöroloji Dergisi. 2017; 23(4): 205-10 18.Ballouz, T. Risk factors, clinical presentation, and outcome of Acinetobac¬ter baumannii bacteremia. Frontiers in cellular and infection microbiology. 2017; 7: 156. https://doi.org/10.3389/fcimb.2017.00156
• 19.Jamulitrat S, Narong MN, Thongpiyapoom S. Trauma severity scoring sys¬tems as predictors of nosocomial infection. Infect Control Hosp Epidemiol. 2002; 23(5): 268-73. https://doi.org/10.1086/502047
• 20.Hazeldine J, Hampson P, Lord JM. The impact of trauma on neutrophil function. Injury. 2014; 45(12): 1824-33 https://doi.org/10.1016/j.injury.2014.06.021
• 21.Bergogne-Berezin E, Towner KJ. Acinetobacter spp. as nosocomial patho¬gens: microbiological, clinical, and epidemiological features. Clinical micro¬biology reviews. 1996; 9: 148-65. https://doi.org/10.1128/CMR.9.2.148
• 22.Baran G, Erbay A, Bodur H et al. Risk factors for nosocomial imipenem-resistant Acinetobacter baumannii infections. Int J Infect Dis. 2008; 12(1): 16-21. https://doi.org/10.1016/j.ijid.2007.03.005
• 23.Paterson DL, Doi Y. A Step Closer to Extreme Drug Resistance (XDR) in GramNegative Bacilli. Clin Infect Dis. 2007; 45(9): 1179-81. https://doi.org/10.1086/522287
• 24.Chang HC, Chen YC, Lin MC et al. Mortality risk factors in patients with Acinetobacter baumannii ventilator-associated pneumonia. Formos Med As¬soc. 2011; 10: 564-71. https://doi.org/10.1016/j.jfma.2011.07.004
• 25.Chen, SY. Bacteremia in previously hospitalized patients: prolonged effect from previous hospitalization and risk factors for antimicrobial-resistant bacterial infections. Annals of Emergency Medicine. 2008; 51:639-46. https://doi.org/10.1016/j.annemergmed.2007.12.022
• 26.Baran G, Erbay A, Bodur H, et al. Risk factors for nosocomial imipenem resistant Acinetobacter baumannii infections. Int J Infect Dis. 2008; 12: 16-21. https://doi.org/10.1016/j.ijid.2007.03.005
• 27.Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: Emergence of a successful pathogen. Clin Microbiol Rev. 2008; 21(3): 538-2. https://doi.org/10.1128/CMR.00058-07
• 28.Huang H. A multi-center study on the risk factors of infection caused by multi-drug resistant Acinetobacter baumannii. BMC infectious diseases. 2018; 18: 1-6. https://doi.org/10.1186/s12879-017-2932-5
• 29.Tünay H, Demirdal T, Demirtürk N. Risk factors for nosocomial pan drug resistant acinetobacter baumannii infections. Acta Medica Alanya. 2019; 33: 254-60. https://doi.org/10.30565/medalanya.543371
• 30.Çelik C.. Increasing antimicrobial resistance in nosocomial pathogens; multidrug-resistant extensively drug-resistant and pandrug-resistant Aci¬netobacter baumannii. Journal of Microbiology and infectious diseases. 2014; 4: 7-12. https://doi.org/10.5799/ahinjs.02.2014.01.0116
• 31.Zhou H, Yao Y, Zhu B, et al. Risk factors for acquisition and mortality of multidrug-resistant Acinetobacter baumannii bacteremia: A retrospective study from a Chinese hospital. Medicine. 2019; 98: 13. https://doi.org/10.1097/MD.0000000000014937
• 32.Ciginskiene A, Dambrauskiene A, Rello J, et al. Ventilator-associated pneu¬monia due to drug-resistant Acinetobacter baumannii: risk factors and mor¬tality relation with resistance profiles, and independent predictors of in-hos¬pital mortality. Medicina. 2019;55.2: 49. https://doi.org/10.3390/medicina55020049