title: Risk factors for carbapenem-resistant Acinetobacter baumanii blood stream infections in a neonatal intensive care unit, Delhi, India.
abstract: BACKGROUND
  Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is being increasingly observed and is associated with significant morbidity and mortality in newborns. In this study, we determined the epidemiology, risk factors, and outcomes of blood stream infection (BSI) caused by CRAB in neonates.
  
  
  METHODS
  The clinical charts of neonates who developed Acinetobacter baumannii BSI in the period between 1 January 2010 and 31 December 2012 were reviewed.
  
  
  RESULTS
  During the study period, 65 neonates developed Acinetobacter baumannii BSI; 33 were CRAB at an incidence of 0.50 case per 1,000 patient-days. Compared with carbapenem-sensitive Acinetobacter baumannii (CSAB), patients with CRAB BSI had significantly higher prior antimicrobial use, longer duration of ventilation, and late isolation of organisms. Feeding with expressed breast milk was protective. All isolates of Acinetobacter baumenii were sensitive to colistin and tigecycline. The all-cause mortality rates were 27.3% in CRAB and 9.4% in CSAB BSI, respectively (p = 0.074).
  
  
  CONCLUSIONS
  Neonatal BSI caused by CRAB was not common but caused high mortality. Feeding with breast milk was protective. Lack of effective antibiotics was the major challenge in treating these patients.
authors.affiliation: Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital. ajayk5@yahoo.com.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.forename: Valinderjeet Singh
authors.initials: VS
authors.lastname: Randhawa
authors.forename: Nilay
authors.initials: N
authors.lastname: Nirupam
authors.forename: Yogita
authors.initials: Y
authors.lastname: Rai
authors.forename: Arvind
authors.initials: A
authors.lastname: Saili
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D015780:Carbapenems / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D008297:Male; D012307:Risk Factors; D016019:Survival Analysis; D018440:beta-Lactam Resistance
chemical_list: D015780:Carbapenems