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Risk Factors and Outcomes of Carbapenem-resistant Acinetobacter baumannii Bacteremia in Neonatal Intensive Care Unit: A Case-case-control Study

Thatrimontrichai, Anucha MD*; Apisarnthanarak, Anucha MD; Chanvitan, Prasin MD*; Janjindamai, Waricha MD*; Dissaneevate, Supaporn MD*; Maneenil, Gunlawadee MD*

Pediatric Infectious Disease Journal: February 2013 - Volume 32 - Issue 2 - p 140–145
doi: 10.1097/INF.0b013e318270b108
Antimicrobial Reviews

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).

Conclusion: 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.

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.

Accepted for publication August 23, 2012.

This work was supported by the Faculty of Medicine, Prince of Songkla University, Thailand (A.T.) and the National Research University Project of the Thailand Office of Higher Education Commission (A.A.) The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Anucha Thatrimontrichai, MD, Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand. E-mail: tanucha@medicine.psu.ac.th.

© 2013 Lippincott Williams & Wilkins, Inc.