Risk factors and antibiotic resistance of pneumonia caused by multidrug resistant <i>Acinetobacter baumannii</i> in pediatric intensive care unit

Cai, Xiujun; Sun, Jianzhong; Bao, Lei; Li, Wenbin

doi:10.5847/wjem.j.issn.1920-8642.2012.03.008

Cited by 22 publications

(25 citation statements)

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“…As a result, it causes persistent hospitalacquired infections (1,2). In our present study, the incidence of MDR/XDR-AB at our facility was 0.48 cases/1000 patient-days, which was consistent with the incidence range from 0 to 58 cases/1000 patient-days (15) and lower than the incidence of another PICU that literature reports (7). Patients in PICU always characterized by more severe underlying diseases, immune dysfunction and more complex medical history, all of these conditions will cause severe infection of A. baumannii.…”

Section: Discussionsupporting

confidence: 89%

“…The incidence of MDR/XDR-AB is higher in children in pediatric intensive care unit (PICU) than in other patients on concern of severe underlying diseases, immune deficiency, and invasive operations. (7) the mortality rate varies from 18.26-88.7% depending on the infection source. (7)(8)(9) The problems for pediatrician in China are polymyxins cannot be obtained, tigecycline only became available in late 2016, and had limited experience in manage these young patients.…”

Section: Introductionmentioning

confidence: 99%

“…(7) the mortality rate varies from 18.26-88.7% depending on the infection source. (7)(8)(9) The problems for pediatrician in China are polymyxins cannot be obtained, tigecycline only became available in late 2016, and had limited experience in manage these young patients. (10) (11) Few studies have evaluated the risk factors for A. baumannii infection in Chinese pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

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MDR/XDR Acinetobacter baumannii hospital infection associated with high mortality: A retrospective study in the PICU

Shi¹,

Sun²,

Cui³

et al. 2019

Preprint

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BackgroundMultiple drug-resistant (MDR) and extensively drug-resistant (XDR) Acinetobacter baumannii presents challenges for clinical treatment and causes high mortality in children. We aimed to assess the risk factors for MDR/XDR Acinetobacter baumannii (MDR/XDR-AB) infection and for 28-day mortality in this patient population. MethodsThis retrospective study included 102 pediatric patients who developed MDR/XDR-AB infection in the pediatric intensive care unit (PICU) of Shanghai Children's Hospital in China from January 2015 to December 2017. Clinical presentations and outcome of the patients were analyzed. Results Of the 102 patients (63 males and 39 females; mean age: 51.79 months), There were 63 (61.77%) male in the case group. The 28-day mortality rate was 29.41%. 18(17.64%) had bloodstream infections;4(3.92%) for which cerebrospinal fluid (CSF) cultures were positive; 14(13.73%) of them got positive cultures in aseptic fluid; 10 (9.8%) had central lineassociated bloodstream infections; lower respiratory isolates (56/102) accounted for 54.9% of all patients. Multivariate logistic analysis indicated that high serum level of BUN (RR, 1.216, 95%CI, 1.27-2.616; P = 0.001) and high serum level of Cr (RR, 1.823, 95%CI, 0.902-0.980), were associated with high risk of mortality in MDR/XDR-AB infected patients.Conclusion MDR/XDR-Ab infection is a serious concern in pediatric patients with high mortality (29.41%).Mortality rate is higher in blood stream infection and central nervous system infection. Acute kidney injury is associated with high risk of mortality. Early use of tigarecycline might be involved in improving MDR/XDR-AB bacteremia.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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MDR/XDR Acinetobacter baumannii hospital infection associated with high mortality: A retrospective study in the PICU

Shi¹,

Sun²,

Cui³

et al. 2019

Preprint

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“…Acinetobacter baumannii is a Gram-negative coccobacillus that has a remarkable ability to acquire antibiotic resistance and that cause persistent nosocomial infections [1] The mortality rate varies from 18.26% to 88.7% depending on the infection source [2,3]. The propensity of Acinetobacter baumannii to be multidrug-resistant (MDR) or extensively drug-resistant (XDR) presents therapeutic challenges [4,5] .…”

Section: Introductionmentioning

confidence: 99%

Multidrug resistant and extensively drug resistant Acinetobacter baumannii hospital infection associated with high mortality: A retrospective study in the Pediatric Intensive Care Unit

Shi

Sun

Cui

et al. 2020

Preprint

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Background Multidrug resistant (MDR) and extensively drug resistant (XDR) Acinetobacter baumannii presents challenges for clinical treatment and causes high mortality in children. We aimed to assess the risk factors and overall mortality for MDR/XDR Acinetobacter baumannii infected pediatric patients. Methods This retrospective study included 102 pediatric patients who developed MDR/XDR Acinetobacter baumannii infection in the pediatric intensive care unit (PICU) of Shanghai Children’s Hospital in China from December 2014 to May 2018. Acinetobacter baumannii clinical isolates were recovered from different specimens including blood, sputum, bronchoalveolar lavage fluid, cerebrospinal fluid, ascites, hydrothorax, and urine. Antibiotic susceptibility test was determined according to the Clinical and Laboratory Standards Institute interpretive criteria. Clinical and biological data were obtained from the patients’ medical records.Results 102 patients with Acinetobacter baumannii infection were enrolled. The median age was 36 (9.6, 98.8) months, and there were 63 male in the case group. The overall mortality rate was 29.4%, while the Acinetobacter baumannii-associated mortality rate was 16.7% (17/102, 12 bloodstream infections, 4 meningitis and 1 intra-abdominal infection). Bloodstream infections occurred in 28 patients (27.5%), and 10 patients (9.8%) among them had central line-associated bloodstream infections (6 central venous catheters, 2 PICCs, 1 venous infusion port and 1 arterial catheter). Cerebrospinal fluid (CSF) cultures were positive in 4(3.9%) patients. 14(13.7%) patients got positive cultures in ascites and hydrothorax. Lower respiratory isolates (56/102) accounted for 54.9% of all patients. Non-survival patients appeared to have a lower NK cell activity (6.2%±3.61% vs. 9.15%±6.21%, P =0.029), higher CD4+ T cell ratio (39.67%±12.18% vs. 32.66%±11.44%, P = 0.039),and a higher serum level of interlukin-8 (IL-8, 15.25 (1.62, 47.22)pg/ml vs. 0.1 (0.1, 22.99)pg/ml, P=0.01) when Acinetobacter baumannii infection developed. Multivariate logistic analysis indicated that high serum level of Cr (RR, 0.934, 95%CI, 0.890-0.981；P=0.007) and high BUN/ALB level (RR, 107.893, 95%CI, 1.425-870.574; p= 0.005) were associated with high risk of mortality in MDR/XDR Acinetobacter baumannii infected patients. Conclusion MDR/XDR Acinetobacter baumannii infection is a serious concern in pediatric patients with high mortality. Bloodstream and central nervous infection accounted for high risk of death. Acute kidney injury is associated with high risk of mortality.

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“…However, the therapy with β-lactam antibiotics remains unresolved since β-lactamase resistance is disseminating rapidly among pathogenic bacteria. The most serious types of β-lactamase resistance today are extended-spectrum β-lactamases (ESBLs), carbapenemases and metallo-β-lactamases (MBLs) [1,4,5].…”

Section: Introductionmentioning

confidence: 99%

Toxicity of β-Lactam Antibiotics: Pathophysiology, Molecular Biology and Possible Recovery Strategies

Bozcal¹,

Dagdeviren²

2017

Poisoning - From Specific Toxic Agents to Novel Rapid and Simplified Techniques for Analysis

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Beta (β)-lactam antibiotics are wide-spectrum antibiotics used for various bacterial infections. The aim of this chapter is to summarize the knowledge about the toxicity of β-lactam antibiotics and issues associated to their inappropriate use. This review has highlighted that β-lactam antibiotics are a group of products that have a chemical structure characterized by a β-lactam ring and are one of the most common antibacterial agents. However, due to the inappropriate use including abuse and misuse, resistance to the β-lactam antibiotics is currently a global crisis. Moreover, even when used appropriately, they have been linked to triggering allergic reactions like urticaria, bronchoconstriction, also severe conditions like immune-mediated haemolytic anaemia and intravascular haemolysis. It is known that some β-lactam antibiotics are neurotoxic, some are nephrotoxic, some are genotoxic and some are toxic to urogenital system. Several factors are involved in the occurrence of toxic efects including the dosage and renal status. Several strategies are possible to overcome β-lactam antibiotics-triggered toxicity, including rational prescribing, substitution combination and phage therapy which seems promising. Public health education for clinical teams and patients is essential in ensuring that this group of antibiotics are retained in therapeutics.

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Risk factors and antibiotic resistance of pneumonia caused by multidrug resistant Acinetobacter baumannii in pediatric intensive care unit

Cited by 22 publications

References 7 publications

MDR/XDR Acinetobacter baumannii hospital infection associated with high mortality: A retrospective study in the PICU

MDR/XDR Acinetobacter baumannii hospital infection associated with high mortality: A retrospective study in the PICU

Multidrug resistant and extensively drug resistant Acinetobacter baumannii hospital infection associated with high mortality: A retrospective study in the Pediatric Intensive Care Unit

Toxicity of β-Lactam Antibiotics: Pathophysiology, Molecular Biology and Possible Recovery Strategies

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