THE INFECTION CAUSED BY ACINETOBACTER BAUMANNII IN THE INTENSIVE CARE UNITS OF A GENERAL HOSPITAL
https://doi.org/10.21292/2078-5658-2017-14-6-22-27
Abstract
The objective of the study: to investigate the course of infection, caused by A. baumannii, in the patients in the intensive care units of a general hospital. Methods. The retrospective cohort study was conducted, which included 830 patients of the intensive care wards suffering from nosocomial infections caused by Acinetobacter baumanii. The bacterial diagnostics and drug susceptibility testing were performed using the analyzer of ADAGIO (Bio Rad, USA), Vitex 2 Compact 60 (bio Mariex, France) and the bacteriological analyzer for testing of sterile blood cultures of Bact Alar 3D60 (bio Mariex, France). As a result, certain specific features of this infection were identified: higher frequency of this disease in the patients with unfavorable co-morbid background (p = 0.042), prevailing lesions of abdomen (p = 0.04), skin and soft tissues (p = 0.02), frequent manifestations of septic shock (14%; p = 0.025) with a high mortality rate (16%; p = 0.025). Conclusions. 1. In 28% of cases, Acinetobacter baumannii accounts for the development of nosocomial infection in the patients staying in the intensive care ward. 2. Abdomen (18%), skin and soft tissues (8%) are most frequent sites where lesions caused by this infection are diagnosed. 3. The co-infection caused by A. baumannii most often develops in the patients with compromised co-morbid background (Charlson score makes 4.6 ± 0.3), which explains the severity of their state (APACHE II score makes 18.0 ± 1.6), development of organ failures (SOFA scores make 6.00 ± 0.05) and high frequency of septic shock (14%; p = 0.025). 4. The high mortality is typical of the course of the infection caused by A. baumannii, (16% versus 5.6%) in the patients with nosocomial infections caused by the other gram-negative bacteria.
About the Authors
L. L. PlotkinRussian Federation
Doctor of Medical Sciences, Leading Intensive Physician, Professor of Faculty Surgery Department of South Ural State Medical University
I. V. Molchanova
Russian Federation
Head of Microbiological Laboratory
P. G. Chumakov
Russian Federation
Head of Intensive Care Department no. 1
M. Yu. Rakhmanov
Russian Federation
Head of Intensive Care Department no. 2
A. Yu. Tyurin
Russian Federation
Head of Intensive Care Department no. 3
Yu. M. Marchenko
Russian Federation
Candidate of Medical Sciences, Head of Intensive Care Department no 4
References
1. Gelfand B.R., Belotserkovskiy B.Z., Milyukova B.Z. et al. Epidemiology and nosologic structure of nosocomial infections in the intensive care units of a general hospital. Infeksii v Khirurgii, 2014, no. 4, pp. 24-36. (In Russ.)
2. Sergienko V.I., Bondareva I.B. Matematicheskaya statistika v klinicheskikh issledovaniyakh. [Mathematical statistics for clinical trials]. Moscow, GEOTAR Meditsina Publ., 2000, 256 p.
3. Yakovlev S.V., Suvorova M.P., Beloborodov V.B. et al. Prevalence and clinical value of nosocomial infection in the medical units of Russia: ERGINI study. Antibiotiki i Khimioterapiya, 2016, vol. 61, no. 5-6, pp. 32-42. (In Russ.)
4. Ballouz T., Aridi J., Afif C. et al. Risk factors, clinical presentation, and outcome of acinetobacter baumannii bacteremia. Crit. Care, 2017, no. 21, pp. 130.
5. Carlet J.M., Artigas A., Niederman M.S. et al. The Barcelona Declaration from the World Alliance against Antibiotic Resistance: engagement of intensivists. Crit. Care, 2012, vol. 16, pp. 145.
6. Charlson M.E., Pompei P., Ales K.L. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chron. Dis., 1987, vol. 40, pp. 373-383.
7. Knaus W.A., Sun V., Nyston P.O. et al. Evaluation of definition for sepsis. Chest, 1992, vol. 101, pp. 1656-1662.
8. Kumar A., Roberts D., Wood K.E. et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit. Care Med., 2006, vol. 34, pp. 1589-1596.
9. Peterson L.R. Bad bugs, no drugs: no ESCAPE revisited. Clin. Infect. Dis., 2009, vol. 49, pp. 992-993.
10. Singer M. The Third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 2016, vol. 315, no. 8, pp. 801-810.
11. Vincent J.L., de Mendonsa A., Cantraine T. et al. Use SOFA scores to asses the incichece of organ dysfunction failure in intensive care units: results of a multicenter, prospective study. Working group on’ sepsis problems of the European Society of Intensive Care. Crit. Care Med., 1998, vol. 26, pp. 1793-1800.
12. Zilberberg M.D., Nathanson B.H., Sulham К. et al. Daily cost of delay to adequate antibiotic treatment among patients surviving a hospitalization with community-onset Acinetobacter baumannii pneumonia or sepsis. Crit. Care, 2017, vol. 21, pp. 130.
Review
For citations:
Plotkin L.L., Molchanova I.V., Chumakov P.G., Rakhmanov M.Yu., Tyurin A.Yu., Marchenko Yu.M. THE INFECTION CAUSED BY ACINETOBACTER BAUMANNII IN THE INTENSIVE CARE UNITS OF A GENERAL HOSPITAL. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2017;14(6):22-27. (In Russ.) https://doi.org/10.21292/2078-5658-2017-14-6-22-27