Multidrug-resistant Acinetobacter baumannii infection among neonates in a neonatal intensive care unit at a medical center in central Taiwan

Abstract

MDRAB infection is responsible for a high mortality rate among neonates in the NICU, especially in those who have neutropenia or thrombocytopenia. Infection control and appropriateness of the initial antimicrobial agent with colistin play an important role in reducing mortality.

Multidrug - Resistant Acinetobacter Species Infection among Neonates

“…[5] Studies from India and other parts of the world have reported prematurity, low birth weight ,mechanical ventilation, presence of prolonged intravenous access(central or peripheral), infection with MDR within 7 days of admission, prior exposure to third generation cephalosporins and delay in starting appropriate antibiotics as significant risk factors associated with mortality. [2,4,5,7,[10][11][12]15] In our study 69.2% of babies were preterm (≤30wk) with birth weight ≤1500gm, all had respiratory distress and were ventilated (100%), 53.84% acquired MDR Acinetobacter within 3 days after birth, there was prior use of cephalosporins in 61.5% cases, inappropriate use of antibiotics in 4 case and delay in 7cases. Study from Karachi described mortality due to neonatal Acinetobacter sepsis in 47% and 70% of them died within 4 days of acquiring infection.…”

“…These findings are similar to other studies from India and abroad. [2,4,5,8,10,[12][13][14][15][16][17] All the isolates in our study were MDRAB (100%).The details of the resistance are displayed in [ Table 4]. Testing for colistin and Polymyxin B was not done.…”

“…[13] Therefore, we are left with only colistin / polymyxin B for the resistant cases. [3,5,10,13,14] Unfortunately, testing for them was not available in our centre.Pan resistance was found in 2 isolates. Recent study from Karachi described Pan resistance (sensitive only to Colistin) in 71%.…”

“…[4] The association between MDR Acinetobacter (MDRAB) and mortality is increasingly established in literature. [4,5,[8][9][10]12,16] There is a dearth of literature identifying factors related to high mortality in neonates with Acinetobacter infection requiring high-level care. We therefore attempt to identify important risk factors associated with increased mortality in neonates with Acinetobacter sepsis.…”

Kajian Penggunaan Antibiotik pada Neonatus Intensive Care Unit di Sebuah Rumah Sakit Pemerintah di Surabaya

“…Sebuah penelitian yang dilakukan di Taiwan menunjukkan hasil bahwa penundaan penggunaan antibiotik yang tepat pada pasien dengan multiple drug resistant Acinetobacter baumanii menjadi salah satu faktor yang dapat meningkatkan risiko kematian bayi di NICU. 9 Selain berdampak pada peningkatan risiko terjadinya kegagalan terapi, salah satu dampak yang perlu diwaspadai adalah potensi terjadinya resistensi ketika antibiotik yang diberikan tidak dapat mencapai kadar minimum untuk menghambat pertumbuhan atau membunuh bakteri. Fenomena resistensi antibiotik merupakan salah satu permasalahan yang banyak dialami di NICU.…”