Multidrug Resistant Acinetobacter species: A significant cause of sepsis in an Intensive care unit in a regional hospital, Durban

Abstract

Abstract

Introduction

Acinetobacter species (A.species) are common hospital environmental bacteria that have gained importance during the past few decades as important nosocomial pathogens in critically ill patients. This problem has been compounded by the worldwide increase in carbapenem-resistant Acinetobacter infections. In South Africa also, multidrug resistant, including carbapenem resistant A. species causing significant sepsis has recently increased. Acinetobacter baumannii remains an important and difficult-to-treat pathogen whose resistance patterns result in significant challenges for the clinician.  The study was conducted to determine the prevalence of MDR-A. species, and to differentiate between significant infection and colonization by correlation with clinical data .

Method

All patients identified with A. species isolates after 48hrs in the intensive care unit (ICU) were included in the study over a year period. Data was recorded prospectively including any underlying chronic disease, type of specimens, antibiogram, antibiotic usage in the unit and outcome during daily ward rounds. Analyses were done retrospectively. 

Results

During the study period, there were 187 isolates from different specimens of 86 patients.  Significant sepsis was identified in 30/86 (35%), colonization in 51/86 (59%) and bacteraemia in 5/86 (6%) patients with A. species respectively. Lack of appropriate treatment resulted in the death of 18/86 (21%) patients. A. species was isolated mainly from endotracheal aspirates 67/187 (36%), and the others were from the various types of specimens. Isolates were multidrug resistant including carbapenem.

Conclusion

MDR- A. species was identified as a significant cause of sepsis and high mortality rate

(p <0.001) among the patients in surgical ICU. Our findings highlight the impact of antibiotic stewardship in the treatment of patients in whom A. species is isolated and the urgent need for the development of standardised guidelines for management of patients with A. species sepsis.

 

Key words:    Multidrug Resistant, Acinetobacter species, colonization, sepsis,   intensive care unit