title: Risk factors and outcomes of carbapenem-resistant Acinetobacter baumannii bacteremia in neonatal intensive care unit: a case-case-control study.
abstract: BACKGROUND
  Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a serious threat among critically ill neonates.
  
  
  METHODS
  We performed a case-case-control study in a Thai neonatal intensive care unit to identify risk factors and outcomes for CRAB bacteremia. Case group (CG) I was defined as cases with CRAB (n = 14), and CG II was defined as cases with carbapenem-susceptible A. baumannii (n = 38) bacteremia. The control group (n = 44) was selected from all patients admitted before and after 3 days that CG I was identified, but had no infection.
  
  
  RESULTS
  The mean gestational age and birth weight of CG I, II and control were 33.5, 35.2 and 35.2 weeks and 1856.5, 2273.9 and 2309.5 g, respectively. By multivariate analysis, CG I was more likely to have had an umbilical artery catheter (adjusted odds ratio = 29.30; P = 0.019) whereas CG II was more likely exposed to ceftazidime (adjusted odds ratio = 5.19; P = 0.046) and aminoglycosides (adjusted odds ratio = 35.59; P = 0.002). There was a significant difference in history of cefoperazone/sulbactam (21.4% versus 0%; P = 0.01) and imipenem use (35.7% versus 0%; P < 0.001) among CG I compared with control. Crude mortality in CG I was higher than CG II (42.9% versus 13.2%; odds ratio = 5.0; P = 0.02).
  
  
  CONCLUSIONS
  Our cohort of neonatal CRAB bacteremia is characterized by a very high mortality. Infection-control interventions inclusive of strict adherence to infection-control process for central vascular line placement and maintenance as well as antimicrobial stewardship program are essential to help reduce CRAB bacteremia.
authors.affiliation: From the *Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla; and †Division of Infectious Diseases, Department of Medicine, Thammasat University Hospital, Pratumthani, Thailand.
authors.forename: Anucha
authors.initials: A
authors.lastname: Thatrimontrichai
authors.forename: Anucha
authors.initials: A
authors.lastname: Apisarnthanarak
authors.forename: Prasin
authors.initials: P
authors.lastname: Chanvitan
authors.forename: Waricha
authors.initials: W
authors.lastname: Janjindamai
authors.forename: Supaporn
authors.initials: S
authors.lastname: Dissaneevate
authors.forename: Gunlawadee
authors.initials: G
authors.lastname: Maneenil
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification*; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D015780:Carbapenems / Q000494:pharmacology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems