Pan-resistant Acinetobacter infection in neonates in Karachi, Pakistan.
BACKGROUND
Pan-resistant Acinetobacter infection has emerged as an important nosocomial pathogen in our inpatient neonates over the past few years.


METHODS
We performed a retrospective chart review during a five-year period (July 2003 - June 2008) of all neonates hospitalized in our neonatal intensive care unit (NICU) who developed Acinetobacter infection to identify mortality-associated risk factors in Acinetobacter neonatal infection.


RESULTS
During the five-year study period, 122 cultures from 78 neonates grew Acinetobacter. Source sites of positive culture were in the following descending order: blood (n = 57), trachea (n = 55), tissue/wound/body fluids (n = 4), eye (n = 4), urine (n = 1), and cerebrospinal fluid (n = 1). Twenty-four (31%) patients had Acinetobacter isolated from more than one site. At the time of admission the mean age was 2.08 +/- 4 days and mean weight was 1.77 +/- 0.88 kg; 75% were premature. Pan-resistance (87/122; sensitive only to Polymyxin) was present in 71% of Acinetobacter isolates. Crude mortality rate of this cohort was 47%, while 70% of patients died within four days after positive Acinetobacter culture. We identified weight of less than 1 kg on admission (p 0.06, adjusted Odds Ratio (AOR) 1.53), gestational age 28 weeks or less (p 0.011, AOR 2.88), poor perfusion (p 0.007, AOR 2.4), thrombocytopenia (p 0.01; AOR 1.6) and metabolic acidosis (p 0.01; AOR 1.67) as predictors associated with poor outcome.


CONCLUSIONS
Pan-resistant Acinetobacter infection is exceedingly fatal in newborns, particularly in premature and very low-birth weight neonates. Rational antibiotic use and vigilant infection control in NICUs are key to controlling multi-drug resistant Acinetobacter infection and improving clinical outcome.
Department of Pediatrics and Child health, Aga Khan University, Karachi -74800 , Pakistan. ali.saleem@aku.edu
Ali Faisal
AF
Saleem
Imran
I
Ahmed
Fatima
F
Mir
Syed Rehan
SR
Ali
Anita Km
AK
Zaidi
D000138:Acidosis / Q000209:etiology; D000150:Acinetobacter / Q000187:drug effects* / Q000302:isolation & purification; D000151:Acinetobacter Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001724:Birth Weight; D001826:Body Fluids / Q000382:microbiology; D003428:Cross Infection / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005123:Eye / Q000382:microbiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000209:etiology; D014132:Trachea / Q000382:microbiology
D000900:Anti-Bacterial Agents