Risk factors associated with multi-drug-resistant Acinetobacter baumannii nosocomial infections at a tertiary care hospital in Makkah, Saudi Arabia - a matched case–control study

Abstract

ObjectiveTo determine risk factors for multi-drug-resistant Acinetobacter baumannii (MDR-AB) nosocomial infections in intensive care units in a tertiary care hospital, Makkah, Saudi Arabia.MethodsWe performed a hospital-based, matched case–control study in patients who were admitted to Al Noor Specialist Hospital between 1 January 2012 and 31 August 2012. The study included cases of A. baumannii nosocomial infection and controls without infection. Controls were matched to cases by age and ward of admission.ResultsThe most frequent site of infection was the respiratory tract (77.3%). Susceptibility to antimicrobial MDR-AB was 92.0% for ceftazidime and ciprofloxacin, while it was 83.3% for imipenem, 83.0% for trimethoprim, 79.0% for amikacin, and 72.7% for gentamicin. Multiple logistic regression of risk factors showed that immunosuppression (OR = 2.9; 95% CI 1.5–5.6; p = 0.002), clinical outcome (OR = 0.4; 95% CI 0.3–0.9; p = 0.01), invasive procedures (OR = 7.9; 95% CI 1.8–34.2; p = 0.002), a central venous catheter (OR = 2.9; 95% CI 1.5–5.6; p = 0.000), and an endotracheal tube (OR = 3.4; 95% CI 1.6–7.3; p = 0.001) were associated with MDR-AB.ConclusionsAcinetobacter nosocomial infections are associated with admission to the ICU (Intensive care unit) and exposure to invasive procedures.

Prevalence of Acinetobacter baumannii in Saudi Arabia: risk factors, antimicrobial resistance patterns and mechanisms of carbapenem resistance

“…Ballouz et al [26] indicated that a prolonged hospital admission is frequently associated with reduction of functionality, and increased exposure to steroids and antibiotics; and these factors seem to impact the mortality of A. baumannii bacteremia. A hospital-based, matched case–control study found that the risk factors associated with carbapenem resistant A. baumannii (CRAB) in nosocomial infections in ICU include immunosuppression, invasive procedures, central venous catheters, and an endotracheal intubation [7]. Gastrointestinal colonization by A. baumannii in ICU patients is a significant risk factor for spreading antimicrobial resistance, increases disease severity and provides an important reservoir for clinical infections and hospital outbreaks [27].…”

“…The patterns of resistance and severity of A. baumannii infection depend upon the patient’s susceptibility to infection as a result of their underlying diseases [30, 31]. Patients with underlying illness such as DM, cancer, renal impairment and chronic pulmonary disorders have immune deficits that lead to increased susceptibility to infection caused by opportunistic pathogens [7, 9, 32]. However, individuals with such conditions tend to become at long-term hospitalization and under frequent invasive diagnostic and therapeutic interventions [33].…”

“…The emergence of A. baumannii strains resistant to broad-spectrum antimicrobial agents in hospital settings has become a major health burden, due to the limited treatment options for infections caused by this pathogen [2, 4, 5]. A. baumannii has to capability to develops resistance mechanisms to a wide range of antimicrobial agents, including carbapenems [2, 6, 7]. The increasing rates of resistance to carbapenems and other therapeutic options such as colistin and polymyxins is alarming, and have become a health issue of global concern [8, 9].…”

The effect of temporary closure and enhanced terminal disinfection using aerosolized hydrogen peroxide of an open-bay intensive care unit on the acquisition of extensively drug-resistant Acinetobacter baumannii

“…A prospective study conducted over 7 years form 2007 to 2014 at a large university hospital in Beirut showed that the a rate of XDR-AB colonization pressure was 315.4 cases/1000 ICU patient-days [ 3 ]. Another matched case–control study from a specialist hospital in the Kingdom of Saudi Arabia between January and August 2012, assessing potential risk factors for XDR-AB acquisition, showed that the proportion of ICU patients who harbored XDR-AB during their stay reached 33% (66/198 patients) [ 23 ]. These figures indicate in our geographical region that XDR-AB is rampant in critical care units.…”

“…In general, risk factors for XDR-AB acquisition may vary from one ICU to the other due to differences in applying standard precautions, compliance to hand hygiene, distance between beds, type of ICU whether open-bay or single-room [ 2 , 32 ]. On the other hand, risk factors including the use of invasive devices, treatment with broad-spectrum antibiotics, length of stay in ICU and contact pressure are commonly reported in several studies [ 2 , 3 , 23 , 33 ].…”