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      Carbapenem-resistant Acinetobacter baumannii infections: Antimicrobial resistance patterns and risk factors for acquisition in a Kenyan intensive care unit

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          Highlights

          • Multidrug-resistant Acinetobacter baumannii (AB) is dominated by carbapenem-resistant AB (83.3%) isolates.

          • AB displays a high multiple antibiotic resistance index, ranging from 0.64-0.91.

          • Risk factors for AB infection were occupation and interhospital referral status.

          • High intensive care unit mortality (20%) among patients with multidrug-resistant AB.

          Abstract

          Objectives

          Multidrug-resistant (MDR) Acinetobacter baumannii (AB), especially carbapenem-resistant (CR) strains, presents a significant challenge in intensive care units (ICUs) but surveillance data in many resource-constrained countries is inadequate. Here, we determined the prevalence of MDRAB and risk factors for infection and mortality in ICU-admitted patients.

          Methods

          A cross-sectional study among 132 consecutive patients between July 2019 and July 2020, with infected patients followed for 30 days from sample collection to ICU discharge/death. Blood, urine, and tracheal aspirate samples were processed following the standard bacteriological procedures. Isolate identity and antimicrobial susceptibility were elucidated by VITEK 2 Compact system.

          Results

          The prevalence of MDRAB was 22.7% (30/132), mostly from urine samples (12.1%, 16/132), and dominated by CRAB (83.3%) that were colistin-nonresistant and exhibited high multiple antibiotic resistance indices, ranging from 0.64-0.91. Risk factors for infection were occupation (adjusted odds ratio = 4.41, P = 0.016) and interhospital referral status (adjusted odds ratio = 0.14, P = 0.001). ICU mortality was 20% (6/30).

          Conclusion

          Our findings underpin the need for strict adherence to and evaluation of infection prevention and control, and continuous surveillance of CRAB in ICU, especially among the risk groups, in the current study setting and beyond.

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          Most cited references28

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          Acinetobacter baumannii: evolution of a global pathogen

          Acinetobacter baumannii is an opportunistic nosocomial pathogen and one of the six most important multidrug-resistant microorganisms in hospitals worldwide. This human pathogen is responsible for a vast array of infections, of which ventilator-associated pneumonia and bloodstream infections are the most common, and mortality rates can reach 35%. Community-acquired infections have also been reported, but few strains have been recovered from environmental sources and infection reservoirs external to the hospital have not been identified. The majority of A. baumannii infections are caused by two main population clones with worldwide distribution. Infection outbreaks are often associated with multidrug resistance, including the recent emergence of strains resistant to all available antibiotics. Nevertheless, A. baumannii virulence traits and pathogenic potential have mostly remained elusive. The recent expansion of A. baumannii sequenced genomes has permitted the development of large-array phylogenomic and phenotypic analyses, which can offer valuable insights into the evolution and adaptation of A. baumannii as a human pathogen. This review summarises these recent advances, with particular focus on A. baumannii evolutionary and genomic aspects, and proposes new avenues of research. © 2013 Federation of European Microbiological Societies. Published by John Wiley & Sons Ltd. All rights reserved.
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            The rising problem of antimicrobial resistance in the intensive care unit

            Mainly due to its extremely vulnerable population of critically ill patients, and the high use of (invasive) procedures, the intensive care unit (ICU) is the epicenter of infections. These infections are associated with an important rise in morbidity, mortality, and healthcare costs. The additional problem of multidrug-resistant pathogens boosts the adverse impact of infections in ICUs. Several factors influence the rapid spread of multidrug-resistant pathogens in the ICU, e.g., new mutations, selection of resistant strains, and suboptimal infection control. Among gram-positive organisms, the most important resistant microorganisms in the ICU are currently methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. In gram-negative bacteria, the resistance is mainly due to the rapid increase of extended-spectrum Beta-lactamases (ESBLs) in Klebsiella pneumonia, Escherichia coli, and Proteus species and high level third-generation cephalosporin Beta-lactamase resistance among Enterobacter spp. and Citrobacter spp., and multidrug resistance in Pseudomonas aeruginosa and Acinetobacter species. To conclude, additional efforts are needed in the future to slow down the emergence of antimicrobial resistance. Constant evaluation of current practice on basis of trends in MDR and antibiotic consumption patterns is essential to make progress in this problematic matter.
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              Insight into Acinetobacter baumannii : pathogenesis, global resistance, mechanisms of resistance, treatment options, and alternative modalities

              Acinetobacter baumannii, once considered a low-category pathogen, has emerged as an obstinate infectious agent. The scientific community is paying more attention to this pathogen due to its stubbornness to last resort antimicrobials, including carbapenems, colistin, and tigecycline, its high prevalence of infections in the hospital setting, and significantly increased rate of community-acquired infections by this organism over the past decade. It has given the fear of pre-antibiotic era to the world. To further enhance our understanding about this pathogen, in this review, we discuss its taxonomy, pathogenesis, current treatment options, global resistance rates, mechanisms of its resistance against various groups of antimicrobials, and future therapeutics.
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                Author and article information

                Contributors
                Journal
                IJID Reg
                IJID Reg
                IJID Regions
                Elsevier
                2772-7076
                25 October 2023
                December 2023
                25 October 2023
                : 9
                : 111-116
                Affiliations
                [1 ]Department of Biomedical Sciences, Kabarak University, P.O. Private Bag 20157, Nakuru, Kenya
                [2 ]Department of Laboratory Medicine, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya
                [3 ]Department of Medical Laboratory Sciences, Kenyatta University, P.O. BOX 43844-00100, Nairobi, Kenya
                Author notes
                [* ]Corresponding author: musyoki.abednego@ 123456ku.ac.ke
                Article
                S2772-7076(23)00106-6
                10.1016/j.ijregi.2023.10.007
                10652105
                38020185
                e1c627bd-818a-4e3c-b2d7-a90c420cb10e
                © 2023 The Author(s)

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 28 September 2023
                : 17 October 2023
                : 20 October 2023
                Categories
                Original Report

                carbapenem resistance,mdr,acinetobacter baumannii,risk factors,mortality,mari

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