title: Multidrug-resistant Acinetobacter baumannii infection among neonates in a neonatal intensive care unit at a medical center in central Taiwan.
abstract: BACKGROUND
  Few studies have focused on multidrug-resistant Acinetobacter baumannii (MDRAB) infection in neonates. The aim of this study was to investigate risk factors for mortality in neonates with MDRAB infection.
  
  
  METHODS
  This retrospective case-series study was conducted at the Children's Hospital of China Medical University, Taichung, Taiwan. All patients hospitalized between January 2010 and December 2013 in the neonatal intensive care unit (NICU) with MDRAB infections were reviewed.
  
  
  RESULTS
  A total of 67 isolates from 59 neonatal patients were positive for MDRAB. Of the 67 isolates, 38 were from blood (56.72%), 16 from sputum (23.88%), seven from pus (10.45%), three from ascites (4.48%), two from cerebrospinal fluid (2.99%), and one from pleural fluid (1.49%). There were five episodes of MDRAB clusters consisting of 28 cases during the study period. The mortality rate due to MDRAB sepsis was 20.34% (12/59). The statistically significant risk factors for mortality due to MDRAB infection were being infected with MDRAB within 7 days of admission to the NICU, use of umbilical vein catheters, absolute neutrophil count < 1500/mm(3), platelet count < 100,000/mm(3), and a delay in initiating adequate antibiotic treatment.
  
  
  CONCLUSIONS
  MDRAB infection is responsible for a high mortality rate among neonates in the NICU, especially in those who have neutropenia or thrombocytopenia. Infection control and appropriateness of the initial antimicrobial agent with colistin play an important role in reducing mortality.
authors.affiliation: Division of Infectious Diseases, Children's Hospital, China Medical University and China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hsiu-Mei
authors.initials: HM
authors.lastname: Wei
authors.affiliation: Division of Infectious Diseases, Children's Hospital, China Medical University and China Medical University Hospital, Taichung, Taiwan.
authors.forename: Yu-Lung
authors.initials: YL
authors.lastname: Hsu
authors.affiliation: Division of Infectious Diseases, College of Medicine and Department of Pediatrics, Children's Hospital of China Medical University and China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hsiao-Chuan
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Division of Infectious Diseases, Children's Hospital, China Medical University and China Medical University Hospital, Taichung, Taiwan.
authors.forename: Tsung-Hsueh
authors.initials: TH
authors.lastname: Hsieh
authors.affiliation: Division of Infectious Diseases, Children's Hospital, China Medical University and China Medical University Hospital, Taichung, Taiwan.
authors.forename: Ting-Yu
authors.initials: TY
authors.lastname: Yen
authors.affiliation: Division of Neonatology, College of Medicine and Department of Pediatrics, Children's Hospital of China Medical University and China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hung-Chih
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Division of Neonatology, College of Medicine and Department of Pediatrics, Children's Hospital of China Medical University and China Medical University Hospital, Taichung, Taiwan.
authors.forename: Bai-Horng
authors.initials: BH
authors.lastname: Su
authors.affiliation: Division of Infectious Diseases, College of Medicine and Department of Pediatrics, Children's Hospital of China Medical University and China Medical University Hospital, Taichung, Taiwan. Electronic address: kapihw@mail.cmuh.org.tw.
authors.forename: Kao-Pin
authors.initials: KP
authors.lastname: Hwang
mesh_terms: D000046:Academic Medical Centers; D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003091:Colistin / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin
keywords: Acinetobacter baumannii; mortality; multidrug-resistant; neonatal intensive care unit; neonate