Bir Üniversite Hastanesinde Çoklu İlaca Dirençli Acinetobacter baumanii ile Oluşan Enfeksiyonların 15 Yıllık Ara ile Risk Faktörleri ve Prognoz Yönünden Araştırılması

Yıl 2024, Cilt: 14 Sayı: 2, 149 - 163, 30.06.2024

Emel Azak Aynur Karadenizli Haluk Vahaboglu

https://doi.org/10.31832/smj.1430446

Öz

Amaç: Sağlık bakımı ilişkili enfeksiyonlarda (SBİE) Acinetobacter baumannii (AB), yüksek antibiyotik direnç oranları nedeniyle önemli bir sorundur. Bu çalışmada, çoklu ilaca dirençli AB (ÇİDAB) SBİE’lerinin, risk faktörlerinin ve prognozun iki farklı zaman diliminde değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Mayıs 2002-Mayıs 2005 (Grup I) ve Ocak 2023-Aralık 2023 (Grup II) tarihleri arasında, ÇİDAB üremesi olan hastaların klinik ve mikrobiyolojik verileri, retrospektif olarak değerlendirildi. ÇİDAB SBİE’lerinin gelişimine ait risk faktörlerini değerlendirmek için, vaka ve kontrol grupları oluşturuldu. Bulgular: Grup I’de 37 vaka ve 26 kontrol hastası, Grup II’de 64 vaka ve 64 kontrol hastası değerlendirildi. En sık SBİE’ler, Grup I’de solunum yolu (%54), Grup II’de kan dolaşımı (%57) enfeksiyonlarıydı. Grup I’de diyabet (p=0,010), kronik akciğer hastalığı (p=0,007) ve hastanede uzun yatış süresi (p=0,004), Grup II’de ise nazogastrik tüp günü (p=0,044) risk faktörü olarak saptandı. Grup I’de kronik akciğer hastalığı, geçirilmiş cerrahi, cerrahi birimlerde yatış, üriner kateter ve nazogastrik tüp kullanımı Grup II’den; Grup II’de, altta yatan hastalık, malignite, YBÜ’ye yatış ve APACHE II skoru Grup I’den yüksekti. Grup I’den II’ye karbapenem kullanımının %43’ten %69’a (p=0,012) ve mortalitenin %30’dan %45’e (p=0,123) arttığı saptandı. Grup II’de %64 tigesiklin direnci ve %5,4 kolistin direnci vardı. Sonuç: Bu çalışmada, geçmişten günümüze ÇİDAB ilişkili kan dolaşımı enfeksiyonlarında belirgin artış, malignitesi olan ve YBÜ’ye yatan hastalarda ÇİDAB enfeksiyonu sıklığı dikkat çekicidir. SBİE öncesi karbapenem kullanımında artış, tigesiklin ve kolistine artan direnç ve yüksek doz tigesiklin kullanım onayının olmaması önemli sorunlardır. Günümüzde mortalite oranlarındaki artış da dikkate alındığında, ÇİDAB enfeksiyonlarına yönelik çok yönlü enfeksiyon kontrol müdahalelerine gereksinim duyulduğu aşikardır.

Anahtar Kelimeler

Acinetobacter baumannii, Sağlık bakımı ilişkili enfeksiyon, Çoklu ilaca direnç, Risk faktörleri, Prognoz

Etik Beyan

Çalışmanın etik kurul onayı Kocaeli Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan (GOKAEK-2024/02.45, proje numarası: 2024/69) alındı.

Destekleyen Kurum

Yok

Proje Numarası

2024/69

An Investigation of Infections Caused by Multidrug Resistant Acinetobacter baumannii in a University Hospital: A 15-year Interval Study on Risk Factors and Prognosis

Öz

Objective: Growing antibiotic resistance and limited treatment options make Acinetobacter baumannii (AB) in healthcare-associated infections (HAI) difficult. This study compares MDRAB-related HAI risk factors and prognosis in our hospital over two time periods. Materials and Methods: MDRAB growth patients’ clinical and microbiological data from May 2002–May 2005 (Group I) and January 2023–December 2023 (Group II) were retrospectively examined. MDRAB-caused HAI risk factors were assessed in case and control groups. Results: This study evaluated 37 cases and 26 controls in Group I and 64 cases and 64 controls in Group II. Most HAIs were respiratory tract infections (54%) in Group I and bloodstream infections (57%) in Group II. Diabetes (p=0.010), chronic lung disease (p=0.007), and prolonged hospital stay (p=0.004) were risk factors in Group I, while nasogastric tube days (p=0.044) were in Group II. Group I had more chronic lung disease, prior surgery, surgical unit admission, urinary catheter, and nasogastric tube use than Group II. Group II had higher underlying disease, malignancy, ICU admission, and APACHE II score than Group I. The mortality rate rose from 30% to 45% (p=0.123), and carbapenem use rose from 43% to 69% (p=0.012). Group II had 64% tigecycline and 5.4% colistin resistance. Conclusion: The study shows a significant rise in MDRAB-related bloodstream infections, especially in malignancy and ICU patients. High carbapenem use before HAI, rising tigecycline and colistin resistance, and the lack of high-dose tigecycline approval are major issues. The rise in mortality rates makes multifaceted infection control interventions for MDRAB infections necessary.

Anahtar Kelimeler

Acinetobacter baumannii, Healthcare associated infection, Multidrug resistance, Risk factors, Prognosis

Proje Numarası

2024/69

Kaynakça

• 1. Pace MC, Corrente A, Passavanti MB, Sansone P, Petrou S, Leone S, et al. Burden of severe infections due to carbapenem-resistant pathogens in intensive care unit. World J Clin Cases. 2023 May 6;11(13):2874-89. doi: 10.12998/wjcc.v11.i13.2874.
• 2. Bergogne-Bérézin E, Towner KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev. 1996 Apr;9(2):148-65. doi: 10.1128/CMR.9.2.148.
• 3. Clark NM, Patterson J, Lynch JP 3rd. Antimicrobial resistance among gram-negative organisms in the intensive care unit. Curr Opin Crit Care. 2003 Oct;9(5):413-23. doi: 10.1097/00075198-200310000-00012.
• 4. Obeidat N, Jawdat F, Al-Bakri AG, Shehabi AA. Major biologic characteristics of Acinetobacter baumannii isolates from hospital environmental and patients' respiratory tract sources. Am J Infect Control. 2014 Apr;42(4):401-4. doi: 10.1016/j.ajic.2013.10.010.
• 5. Wong D, Nielsen TB, Bonomo RA, Pantapalangkoor P, Luna B, Spellberg B. Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges. Clin Microbiol Rev. 2017 Jan;30(1):409-47. doi: 10.1128/CMR.00058-16.
• 6. Tahseen U, Talib MT. Acinetobacter Infectıons As An Emergıng Threat In Intensıve Care Unıts. J Ayub Med Coll Abbottabad. 2015 Jan-Mar;27(1):113-6.
• 7. Tabah A, Buetti N, Staiquly Q, Ruckly S, Akova M, Aslan AT, et al. Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study. Intensive Care Med. 2023 Feb;49(2):178-90. doi: 10.1007/s00134-022-06944-2.
• 8. Bartsch SM, McKinnell JA, Mueller LE, Miller LG, Gohil SK, Huang SS, et al. Potential economic burden of carbapenem-resistant Enterobacteriaceae (CRE) in the United States. Clin Microbiol Infect. 2017 Jan;23(1):48.e9-48.e16. doi: 10.1016/j.cmi.2016.09.003.
• 9. Lin MF, Lan CY. Antimicrobial resistance in Acinetobacter baumannii: from bench to bedside. World J Clin Cases. 2014;2:787–814. doi: 10.12998/wjcc.v2.i12.787.
• 10. 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 Sep 7;5(8):acmi000637.v3. doi: 10.1099/acmi.0.000637.v3.
• 11. De Blasiis MR, Sciurti A, Baccolini V, Isonne C, Ceparano M, Iera J, et al. Impact of antibiotic exposure on antibiotic-resistant Acinetobacter baumannii isolation in intensive care unit patients: a systematic review and meta-analysis. J Hosp Infect. 2024 Jan;143:123-39. doi: 10.1016/j.jhin.2023.11.002.
• 12. Cisneros JM, Rodríguez-Baño J. Nosocomial bacteremia due to Acinetobacter baumannii: epidemiology, clinical features and treatment. Clin Microbiol Infect. 2002 Nov;8(11):687-93. doi: 10.1046/j.1469-0691.2002.00487.x.
• 13. Karakonstantis S, Gikas A, Astrinaki E, Kritsotakis EI. Excess mortality due to pandrug-resistant Acinetobacter baumannii infections in hospitalized patients. J Hosp Infect. 2020 Nov;106(3):447-53. doi: 10.1016/j.jhin.2020.09.009.
• 14. Manchanda V, Sanchaita S, Singh N. Multidrug resistant Acinetobacter. J Glob Infect Dis. 2010 Sep;2(3):291-304. doi: 10.4103/0974-777X.68538.
• 15. European Committee on Antimicrobial Susceptibility Testing Breakpoint tables for interpretation of MICs and zone diameters Version 14.0, valid from 2024-01-01, pp:27-31. ‘’https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_14.0_Breakpoint_Tables.pdf’’ sitesinde. Erişim tarihi: 21 Ocak 2024.
• 16. Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis. 2018 Mar;18(3):318-27. doi: 10.1016/S1473-3099(17)30753-3.
• 17. Wadl M, Heckenbach K, Noll I, Ziesing S, Pfister W, Beer J, et al. Increasing occurrence of multidrug-resistance in Acinetobacter baumannii isolates from four German University Hospitals, 2002-2006. Infection. 2010 Feb;38(1):47-51. doi: 10.1007/s15010-009-9225-x.
• 18. Dinc U, Bayramoglu G, Buruk K, Ulusoy H, Tosun I, Kaklikkaya N. Molecular epidemiology of Acinetobacter baumannii-Acinetobacter calcoaceticus complex isolated from clinical specimens at an intensive care unit. Saudi Med J. 2010 Apr;31(4):453-5.
• 19. Bulut ME, Öncül A. Nosocomial Infection Agents of Şişli Hamidiye Etfal Training and Research Hospital: Comparison of 1995 and 2017 Data. Sisli Etfal Hastan Tip Bul. 2020 Mar 24;54(1):78-82. doi: 10.14744/SEMB.2019.03271.
• 20. Önal U, Tüzemen Ü, Kazak E, Gençol N, Souleiman E, İmer H, et al. Effects of COVID-19 pandemic on healthcare-associated infections, antibiotic resistance and consumption rates in intensive care units. Infez Med. 2023 Jun 1;31(2):195-203. doi: 10.53854/liim-3102-7.
• 21. Alcántar-Curiel MD, Huerta-Cedeño M, Jarillo-Quijada MD, Gayosso-Vázquez C, Fernández-Vázquez JL, Hernández-Medel ML, et al. Gram-negative ESKAPE bacteria bloodstream infections in patients during the COVID-19 pandemic. PeerJ. 2023 Mar 29;11:e15007. doi: 10.7717/peerj.15007. 10.1093/cid/ciab688.
• 22. Smolyakov R, Borer A, Riesenberg K, Schlaeffer F, Alkan M, Porath A, et al. Nosocomial multi-drug resistant Acinetobacter baumannii bloodstream infection: risk factors and outcome with ampicillin-sulbactam treatment. J Hosp Infect. 2003 May;54(1):32-8. doi: 10.1016/s0195-6701(03)00046-x.
• 23. Abbo A, Navon-Venezia S, Hammer-Muntz O, Krichali T, Siegman-Igra Y, Carmeli Y. Multidrug-resistant Acinetobacter baumannii. Emerg Infect Dis. 2005 Jan;11(1):22-9. doi: 10.3201/eid1101.040001.
• 24. Baran G, Erbay A, Bodur H, Öngürü P, Akıncı E, Balaban N, et al. Risk factors for nosocomial imipenem-resistant Acinetobacter baumannii infections. Int J Infect Dis. 2008 Jan; 12(1):16-21. doi: 10.1016/j.ijid.2007.03.005.
• 25. Mody L, Gibson KE, Horcher A, Prenovost K, McNamara SE, Foxman B, et al. Prevalence of and risk factors for multidrug-resistant Acinetobacter baumannii colonization among high-risk nursing home residents. Infect Control Hosp Epidemiol. 2015 Oct;36(10):1155-62. doi: 10.1017/ice.2015.143.
• 26. Huang H, Chen B, Liu G, Ran J, Lian X, Huang X, et al. A multi-center study on the risk factors of infection caused by multi-drug resistant Acinetobacter baumannii. BMC Infect Dis. 2018 Jan 5;18(1):11. doi: 10.1186/s12879-017-2932-5.
• 27. Kızılarslanoğlu MC, Ergönül O, Çetinkaya Şardan Y, Akova M. Yoğun bakım ünitesinde Acinetobacter baumannii Kolonizasyonu ve İnfeksiyonu: Risk Faktörleri, Bulaşma Yolları ve Bulaşma Dinamikleri. Klimik Derg 2018, 31(1):20-9. doi:10.5152/kd.2018.07.
• 28. Meschiari M, Kaleci S, Orlando G, Selmi S, Santoro A, Bacca E, et al. Risk factors for nosocomial rectal colonization with carbapenem-resistant Acinetobacter baumannii in hospital: a matched case-control study. Antimicrob Resist Infect Control. 2021 Apr 8;10(1):69. doi: 10.1186/s13756-021-00919-6.
• 29. Zhang Y, Xu G, Miao F, Huang W, Wang H, Wang X. Insights into the epidemiology, risk factors, and clinical outcomes of carbapenem-resistant Acinetobacter baumannii infections in critically ill children. Front Public Health. 2023 Nov 30;11:1282413. doi: 10.3389/fpubh.2023.1282413.
• 30. Yu H, Hu R, Hu X, Lu Y, Yao Y, Su J. Risk factors for bacteremia and mortality due to multidrug-resistant Acinetobacter baumannii: a retrospective study. Lett Appl Microbiol. 2024 Jan 22:ovae006. doi: 10.1093/lambio/ovae006.
• 31. Jiang Y, Ding Y, Wei Y, Jian C, Liu J, Zeng Z. Carbapenem-resistant Acinetobacter baumannii: A challenge in the intensive care unit. Front Microbiol. 2022 Nov 10;13:1045206. doi: 10.3389/fmicb.2022.1045206.
• 32. Ayobami O, Willrich N, Suwono B, Eckmanns T, Markwart R. The epidemiology of carbapenem-non-susceptible Acinetobacter species in Europe: analysis of EARS-Net data from 2013 to 2017. Antimicrob Resist Infect Control. 2020 Jun 19;9(1):89. doi: 10.1186/s13756-020-00750-5.
• 33. Blot S, Vandewoude K, Colardyn F. Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients: a matched cohort study. Intensive Care Med. 2003; 29(3): 471-5.
• 34. Özvatan T, Akalın H, Sınırtaş M, Ocakoğlu G, Yılmaz E, Heper Y, et al. Nosocomial Acinetobacter pneumonia: Treatment and prognostic factors in 356 cases. Respirology. 2016 Feb;21(2):363-9. doi: 10.1111/resp.12698.
• 35. Brotfain E, Borer A, Koyfman L, Saidel-Odes L, Frenkel A, Gruenbaum SE, et al. Multidrug Resistance Acinetobacter Bacteremia Secondary to Ventilator-Associated Pneumonia: Risk Factors and Outcome. J Intensive Care Med. 2017 Oct;32(9):528-534. doi: 10.1177/0885066616632193.
• 36. Deshwal PR, Fathima R, Aggarwal M, Reddy NS, Tiwari P. A systematic review and meta-analysis for risk factor profiles in patients with resistant Acinetobacter baumannii infection relative to control patients. Int J Risk Saf Med. 2023;34(4):337-355. doi: 10.3233/JRS-220037.
• 37. 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. Crit Care. 2006;10(2):R48. doi: 10.1186/cc4869.
• 38. Kao HH, Peng CK, Sheu CC, Lin YC, Chan MC, Wang SH, et al. Mortality and ventilator dependence in critically ill patients with ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii. J Microbiol Immunol Infect. 2023 Aug;56(4):822-32. doi: 10.1016/j.jmii.2023.04.004.
• 39. Çelik N, Çelik O, Aslan H, SAvaş G, Yilmaz S. Erzurum Bölge Eğitim ve Araştırma Hastanesi’nde Tespit Edilen Acinetobacter baumannii Suşlarının Antibiyotik Direnç Oranları. Sakarya Tıp Dergisi. Ocak 2018;7(4):229-34.
• 40. Novović K, Jovčić B. Colistin Resistance in Acinetobacter baumannii: Molecular Mechanisms and Epidemiology. Antibiotics (Basel). 2023 Mar 4;12(3):516. doi: 10.3390/antibiotics12030516.
• 41. Shi J, Cheng J, Liu S, Zhu Y, Zhu M. Acinetobacter baumannii: an evolving and cunning opponent. Front Microbiol. 2024 Jan 22;15:1332108. doi: 10.3389/fmicb.2024.1332108.
• 42. Bostanghadiri N, Narimisa N, Mirshekar M, Dadgar-Zankbar L, Taki E, Navidifar T, et al. Prevalence of colistin resistance in clinical isolates of Acinetobacter baumannii: a systematic review and meta-analysis. Antimicrob Resist Infect Control. 2024 Feb 28;13(1):24. doi: 10.1186/s13756-024-01376-7.
• 43. Han H, Qin W, Zheng Y, Cao D, Lu H, Zhang L, Cui Y, Hu Y, Li W, Guo H, Wu D, Li C, Wang H, Chen Y. High-Dose versus Standard-Dose Tigecycline Treatment of Secondary Bloodstream Infections Caused by Extensively Drug-Resistant Acinetobacter baumannii: An Observational Cohort Study. Infect Drug Resist. 2021 Sep 18;14:3837-3848. doi: 10.2147/IDR.S322803.