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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e318270b108
Antimicrobial Reviews

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*

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Abstract

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.

© 2013 Lippincott Williams & Wilkins, Inc.

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