Risk factors for nosocomial imipenem-resistant Acinetobacter baumannii infections

Summary Objectives To identify the risk factors for nosocomial imipenem-resistant Acinetobacter baumannii (IRAB) infections. Methods A prospective case–control study, set in an 1100-bed referral and tertiary-care hospital, of all patients who had nosocomial A. baumannii infections between January 1...

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Bibliographic Details
Published in:International journal of infectious diseases 2008-01, Vol.12 (1), p.16-21
Main Authors: Baran, Gülseren, Erbay, Ayse, Bodur, Hürrem, Öngürü, Pınar, Akıncı, Esragül, Balaban, Neriman, Çevik, Mustafa A
Format: Article
Language:English
Subjects:
Acinetobacter baumannii
Acinetobacter baumannii - drug effects
Acinetobacter Infections - drug therapy
Acinetobacter Infections - epidemiology
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - pharmacology
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Biological and medical sciences
Case-Control Studies
Cross Infection - drug therapy
Cross Infection - epidemiology
Drug Resistance, Multiple, Bacterial - drug effects
Female
General aspects
Hospitals, Teaching - statistics & numerical data
Human infectious diseases. Experimental studies and models
Humans
Imipenem - pharmacology
Imipenem resistance
Infectious Disease
Infectious diseases
Intensive Care Units
Length of Stay
Male
Medical sciences
Microbial Sensitivity Tests
Middle Aged
Nosocomial infection
Pharmacology. Drug treatments
Prospective Studies
Pulmonary/Respiratory
Risk Factors
Sentinel Surveillance
Turkey - epidemiology
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Summary:Summary Objectives To identify the risk factors for nosocomial imipenem-resistant Acinetobacter baumannii (IRAB) infections. Methods A prospective case–control study, set in an 1100-bed referral and tertiary-care hospital, of all patients who had nosocomial A. baumannii infections between January 1 and December 31, 2004. Only the first isolation of A. baumannii was considered. Results IRAB was isolated from 66 (53.7%) patients and imipenem-sensitive Acinetobacter baumannii (ISAB) was isolated from 57 (46.3%) patients during the study period. The mean duration of hospital stay until A. baumannii isolation was 20.8 ± 13.6 days in IRAB infections, whereas it was 15.4 ± 9.4 days in ISAB infections. Of the patients, 65.2% with IRAB infections and 40.4% with ISAB infections were followed at the intensive care unit (ICU). Previous carbapenem use was present in 43.9% of the patients with IRAB and 12.3% of the patients with ISAB infection. In univariate analysis female sex, longer duration of hospital stay until infection, ICU stay, emergent surgical operation, total parenteral nutrition, having a central venous catheter, endotracheal tube, urinary catheter or nasogastric tube, previous antibiotic use, and previous administration of carbapenems were significant risk factors for IRAB infections ( p < 0.05). In multivariate analysis, longer duration of hospital stay until A. baumannii isolation (odds ratio (OR) 1.043; 95% confidence interval (CI) 1.003–1.084; p = 0.032), previous antibiotic use (OR 5.051; 95% CI 1.004–25.396; p = 0.049), and ICU stay (OR 3.100; 95% CI 1.398–6.873; p = 0.005) were independently associated with imipenem resistance. Conclusions Our results suggest that the nosocomial occurrence of IRAB is strongly related to an ICU stay and duration of hospital stay, and that IRAB occurrence may be favored by the selection pressure of previously used antibiotics.
ISSN:1201-9712
1878-3511
DOI:10.1016/j.ijid.2007.03.005