Risk factors and antibiotic resistance of pneumonia caused by multidrug resistant Acinetobacter baumannii in pediatric intensive care unit

doi:10.5847/wjem.j.issn.1920-8642.2012.03.008

Abstract

Abstract:

BACKGROUND: With beta-lactam drugs and immunosuppressants widely used, the infection caused by Acinetobacter baumannii (Ab) has become more and more serious with multidrug resistant Acinetobacter baumannii (MDRAb) emerging and worsening rapidly. Compared with other patients, the incidence and multidrug resistance of MDRAb are higher in children in pediatric intensive care unit (PICU) because of immune deficiency, severe basic diseases, prolonged hospitalization and invasive operations. Hence it is significant to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence of MDRAb in children.

METHODS: A total 115 patients with MDRAb pneumonia and 45 patients with negative MDRAb (NMDRAb) pneumonia who had been treated from January 2009 to August 2011 were studied retrospectively at the PICU of Wuhan Children's Hospital. Clinical data were analyzed with univariate and multivariate Logistic regression.

RESULTS: In 176 clinical strains of Acinetobacter baumannii isolated, there were 128 strains of MDRAb, accounting for 72.73%. Drug susceptibility tests showed that the resistance rates of β-lactam antibiotics were more than 70% except for cefoperazone sulbactam. The rates to carbapenems were higher than 90%. They were significantly higher than those of NMDRAb. Amikacin, levofloxacin, ciprofloxacin and minocycline had the lowest drug-resistance rates (<20%). Multivariate Logistic regression revealed that ICU stay, the time of mechanical ventilation, anemia, hypoproteinemia and the use of carbapenems were independent risk factors for MDRAb pneumonia.

CONCLUSIONS: MDRAb is an important opportunistic pathogen to pneumonia in PICU, and its drug-resistance is severe. It increases significantly the mortality of patients. It is important to take the effective prevention measures for controlling it.

Key words: Pediatric, Intensive Care Unit, Multidrug resistance, Acinetobacter baumannii, Pneumonia, Risk factor, Retrospective study

Xiao-fang Cai, Ji-min Sun, Lian-sheng Bao, Wen-bin Li. Risk factors and antibiotic resistance of pneumonia caused by multidrug resistant Acinetobacter baumannii in pediatric intensive care unit[J]. World Journal of Emergency Medicine, 2012, 3(3): 202-207.

Figures/Tables 4

Table 1

Table 2

Table 3

Univariate analysis of risk factors for MDRAb pneumonia (categorical variables) (n, %)

Risk factors	NMDRAb group (n=45)	MDRAb group (n=115)	t	P	OR (95%CI)
Sex (male)	36 (80)	91 (79.13)	0.01	0.920	0.948 (0.402-2.235)
Use of tranquilizers	8 (17.78)	36 (31.3)	2.97	0.085	2.108 (0.892-4.980)
Immunosuppressive agents	6 (13.33)	24 (20.87)	1.21	0.271	1.714 (0.650-4.523)
Use of antacids	4 (8.89)	6 (5.22)	0.25	0.469	0.564 (0.152-2.102)
Tracheal intubation	10 (22.22)	56 (48.7)	9.35	0.002	3.322 (1.504-7.336)
Urinary catheter	1 (2.22)	3 (2.61)	0.18	0.685	1.179 (0.119-11.637)
Venous catheterization	3 (6.67)	21 (18.26)	3.41	0.084	3.128 (0.884-11.062)
WBC (<4.0×10⁹ or >10×10⁹)	32 (71.11)	96 (83.48)	0.77	0.122	2.053 (0.912-4.619)
Hb (<100 g/L)	30 (66.67)	108 (93.91)	20.25	0.000	7.714 (2.883-20.640)
ALB (<30 g/L)	4 (8.89)	45 (39.13)	13.92	0.000	6.589 (2.209-19.655)
Fungal infection	20 (44.44)	54 (46.96)	0.08	0.888	0.951 (0.479-1.888)
Other bacterial infections	26 (57.78)	69 (60)	0.07	0.791	1.096 (0.545-2.206)
Use of antibiotics
Second-generation cephalosporins	12 (26.67)	48 (41.74)	3.14	0.076	1.970 (0.924-4.203)
Third and fourth generation cephalosporins	38 (84.44)	97 (84.35)	0.00	1.000	0.993 (0.384-2.567)
Carbapenems	38 (84.44)	112 (97.39)	7.18	0.006	6.878 (1.693-27.936)
Aminoglycoside	6 (13.33)	39 (33.91)	6.78	0.009	3.336 (1.3-8.558)
Fluoroquinolones	16 (33.33)	66 (57.39)	6.17	0.013	2.441 (1.196-4.983)
Macrolide	12 (26.67)	51 (44.35)	4.24	0.040	2.191 (1.029-4.668)
Basic diseases
Severe pneumonia	34 (75.56)	88 (76.52)	0.02	0.888	1.055 (0.471-2.359)
Congenital heart disease	12 (26.67)	36 (31.3)	0.33	0.566	1.253 (0.581-2.705)
Sepsis	10 (22.22)	24 (20.87)	0.04	0.841	0.923 (0.401-2.123)
Central nervous system infection	4 (8.89)	18 (15.65)	1.25	0.264	1.902 (0.606-5.967)
Severe diarrheal disease	3 (6.67)	9 (7.83)	0.01	0.920	1.189 (0.307-4.607)
Malnutrition	1 (2.22)	6 (5.22)	0.16	0.689	2.422 (0.283-20.705)
Poisoning	1 (2.22)	4 (3.48)	0.01	0.920	1.586 (0.172-14.584)
Bronchial foreign body	1 (2.22)	3 (2.61)	0.18	0.671	1.179 (0.119-11.637)
Hemophagocytic syndrome	1 (2.22)	3 (2.61)	0.18	0.671	1.179 (0.119-11.637)
Drowning syndrome	1 (2.22)	3 (2.61)	0.18	0.671	1.179 (0.119-11.637)
Guillain-Barre syndrome	1 (2.22)	2 (1.74)	0.2	0.655	0.779 (0.069-8.807)
Spinal muscular atrophy	1 (2.22)	1 (0.87)	0.01	0.920	0.386 (0.024-6.307)

Table 3

Table 4

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Antibiotics	NMDRAb group (n=48)			MDRAb group (n=128)			χ²	P
Antibiotics	n	Resistant trains	Resistance rate	n	Resistant trains	Resistance rate	χ²	P
Amikacin	48	1	2.08	128	12	9.38	3.06	0.118
Ampicillin-sulbactam	48	18	37.5	128	120	93.75	65.24	0.000
Cefepime	48	36	75	128	122	95.31	13.55	0.000
Cefoperazone-sulbactam	48	2	4.17	128	38	29.69	12.95	0.000
Cefazidime	48	40	83.33	128	122	95.31	5.30	0.014
Cefatriaxone	48	38	79.17	128	122	95.31	9.14	0.002
Ciprofloxcin	48	4	8.33	128	20	15.63	1.58	0.209
Imipenem	48	2	4.17	128	116	90.63	118.1	0.000
Levofloxacin	48	4	8.33	128	22	17.19	2.17	0.141
Meropenem	48	2	4.17	128	122	95.31	139.32	0.000
Piperazone-sulbactam	40	16	40	86	80	93.02	42.31	0.000
Sulfamethoxazole-trimethoprim	46	34	73.91	128	98	76.56	0.13	0.718
Minocycline	48	3	6.25	128	16	12.5	1.42	0.233

Risk factors	NMDRAb group (n=45)	MDRAb group (n=115)	t	P
Age (years)	5.59±3.17	6.08±3.7	0.78	0.437
Critical illness score	80.29±8.65	76±7.23	3.19	0.002
During of hospitalization (d)	14.48±3.97	19.21±8.56	3.56	0.001
ICU length of stay (d)	14.43±3.92	17.39±7.05	2.66	0.009
Time of hospital-acquired infection (d)	5.62±2.42	7.47±3.96	2.92	0.004
Time of mechanical ventilation (d)	8.29±3.1	11.76±5.98	3.70	0.000
Time of deep venous catheterization (d)	21±5.1	19.14±8.05	1.44	0.152
Type of antibiotics used	5.91±2.09	7.92±2.8	4.36	0.000
Time of antibiotics used (d)	14.48±3.97	19.21±8.56	3.56	0.001

Independent risk factors	Wald	P	OR	95%CI
ICU length of stay (d)	5.589	0.018	0.351	0.147-0.836
Time of mechanical ventilation (d)	5.023	0.025	1.271	1.031-1.567
Hb (<100 g/L)	8.46	0.004	6.92	1.879-25.48
ALB (<30 g/L)	5.439	0.02	5.119	1.298-20.191
Use of carbapenems	4.455	0.035	9.239	1.172-72.819

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