title: Risk factors and outcomes of carbapenem-resistant Acinetobacter baumannii ventilator-associated pneumonia in the neonate: A case-case-control study.
abstract: BACKGROUND
  Carbapenem-resistant and susceptible Acinetobacter baumannii (CRAB and CSAB) have emerged as serious threats among critically ill neonates. We aimed to identify the risks and outcomes for CRAB and CSAB ventilator-associated pneumonia (VAP) compared with a control group.
  
  
  METHODS
  We performed a retrospective and case-case-control study in a neonatal intensive care unit between 2009 and 2014.
  
  
  RESULTS
  The numbers of patients in the CRAB VAP, CSAB VAP, and control groups were 63, 13, and 25, respectively. The mean gestational ages and median birthweights of CRAB VAP, CSAB VAP, and control groups were 33.2, 35.0, and 32.6 weeks and 1800, 2230, and 2245 g, respectively. By multivariate analysis, infants who had a birthweight of 1000-1499 g (P = 0.04), cesarean section (P = 0.01), history of cephalosporin use (P = 0.02), and surfactant replacement (P = 0.01) in CRAB VAP were significantly higher than in the control group. Inborn infant (P = 0.01), reintubation (P = 0.04), and umbilical artery catheterization (P = 0.04) in the CRAB VAP group were significantly more than in the CSAB VAP group. The crude mortality rates (CMRs) of CRAB VAP and CSAB VAP were 15.9% and 7.7%, respectively. By univariate analysis, the CMR, septic shock, and bronchopulmonary dysplasia in CRAB VAP were higher than in the control group.
  
  
  CONCLUSIONS
  There are very high mortality and short-term morbidity rates in CRAB VAP. Surfactant replacement therapy, fewer cesarean sections, and the reduced use of cephalosporin in very preterm infants may reduce CRAB VAP.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. Electronic address: anuchanicu@hotmail.com.
authors.forename: Anucha
authors.initials: A
authors.lastname: Thatrimontrichai
authors.affiliation: Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; Songkhla Hospital, Songkhla, Thailand.
authors.forename: Chirabat
authors.initials: C
authors.lastname: Techato
authors.affiliation: Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
authors.forename: Supaporn
authors.initials: S
authors.lastname: Dissaneevate
authors.affiliation: Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
authors.forename: Waricha
authors.initials: W
authors.lastname: Janjindamai
authors.affiliation: Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
authors.forename: Gunlawadee
authors.initials: G
authors.lastname: Maneenil
authors.affiliation: Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
authors.forename: Supika
authors.initials: S
authors.lastname: Kritsaneepaiboon
authors.affiliation: Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
authors.forename: Pattama
authors.initials: P
authors.lastname: Tanaanantarak
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy*; D040981:Acinetobacter baumannii / Q000187:drug effects*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D016022:Case-Control Studies; D002511:Cephalosporins / Q000008:administration & dosage; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D011663:Pulmonary Surfactants / Q000008:administration & dosage; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins; D011663:Pulmonary Surfactants
keywords: Acinetobacter baumannii; Carbapenem; Colonization pressure; Drug resistance; Newborn; Pneumonia