Multi-drug resistant Acinetobacter species: a seven-year experience from a tertiary care center in Lebanon

Abstract

BackgroundAcinetobacter species have become increasingly common in the intensive care units (ICU) over the past two decades, causing serious infections. At the American University of Beirut Medical Center, the incidence of multi-drug resistant Acinetobacter baumannii (MDR-Ab) infections in the ICU increased sharply in 2007 by around 120%, and these infections have continued to cause a serious problem to this day.MethodsWe conducted a seven-year prospective cohort study between 2007 and 2014 in the ICU. Early in the epidemic, a case-control study was performed that included MDR-Ab cases diagnosed between 2007 and 2008 and uninfected controls admitted to the ICU during the same time.ResultsThe total number of patients with MDR-Ab infections diagnosed between 2007 and 2014 was 128. There were also 99 patients with MDR-Ab colonization without evidence of active infection between 2011 and 2014. The incidence of MDR-Ab transmission was 315.4 cases/1000 ICU patient-days. The majority of infections were considered hospital-acquired (84%) and most consisted of respiratory infections (53.1%). The mortality rate of patients with MDR-Ab ranged from 52% to 66%.ConclusionMDR-Ab infections mostly consisted of ventilator-associated pneumonia and were associated with a very high mortality rate. Infection control measures should be reinforced to control the transmission of these organisms in the ICU.

Insights into Acinetobacter baumannii: A Review of Microbiological, Virulence, and Resistance Traits in a Threatening Nosocomial Pathogen

“…In a seven-year survey of MDR A. baumannii infections in a tertiary care center in Lebanon, the most common site of infection among the isolates was the respiratory tract (53.1%), followed by surgical wound (18.8%), blood (15.6%), urine (10.2%), and others (2.3%). The most common colonization site was the respiratory tract (80.8%) followed by skin colonization (12.4%) [30]. In a more recent investigation from a university hospital, rates of MDR, XDR, and PDR A. baumannii recovered from VAP cases were 13.3%, 68.3%, and 18.3%, respectively, with female gender and red blood cell transfusion as independent risk factors for mortality [31].…”

Acinetobacter spp in a Third World Country with Socio-economic and Immigrants Challenges

“…In this report, molecular typing of isolates revealed one major PFGE pattern suggesting a clonal spread of this bacterium in the clinical setting [14]. A. baumannii in Lebanon was mostly implicated in ventilator associated pneumoniae [15,16], urinary tract, intra-abdominal, blood and wound infections [17][18][19]. Furthermore, unique cases of necrotizing fasciitis caused by multi-drug resistant A. baumannii were also reported [20,21].…”

“…In one of the aforementioned necrotizing fasciitis cases, the strain was only sensitive to amikacin and polymyxin, challenging therefore the available treatment [21]. Besides A. baumannii, other species in this genus such as A. junii and A. lwoffii were also reported in the Lebanese clinical settings [17]. Kanj et al associated Acinetobacter anitratus bacteremia to an early relapse of thrombotic thrombocytopenic purpura in a 58 years old male during plasma exchange therapy in 2003 [22].…”

Incidence of ventilator associated pneumonia and drug-resistant bacterial preponderance: a fact to ponder

“…Acinetobacter contamination in the ICUs has been found to be one of the recurrent causes of outbreaks of hospital acquired infections like VAP, which is reflected in the present study. 22 Moreover, patients with Acinetobacter baumannii infections in the ICUs are a significant risk factor for subsequent patients to develop VAP due to Acinetobacter baumannii. 20 Authors too in this study evidenced a high incidence of VAP due to Acinetobacter baumannii in the 1 st segment of the year where Acinetobacter baumannii isolation was maximum.…”