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. 2022 Jun 20;37(24):e196.
doi: 10.3346/jkms.2022.37.e196.

The Changes in Epidemiology of Imipenem-Resistant Acinetobacter baumannii Bacteremia in a Pediatric Intensive Care Unit for 17 Years

Dongsub Kim #  1   2 , Haejeong Lee #  3 , Joon-Sik Choi  4 , Christina M Croney  5 , Ki-Sup Park  6   7 , Hyo Jung Park  8 , Joongbum Cho  9 , Sohee Son  1 , Jin Yeong Kim  10 , Soo-Han Choi  11 , Hee Jae Huh  12 , Kwan Soo Ko  13 , Nam Yong Lee  12 , Yae-Jean Kim  1   14
Affiliations

The Changes in Epidemiology of Imipenem-Resistant Acinetobacter baumannii Bacteremia in a Pediatric Intensive Care Unit for 17 Years

Dongsub Kim et al. J Korean Med Sci. .

Abstract

Background: Acinetobacter baumannii infections cause high morbidity and mortality in intensive care unit (ICU) patients. However, there are limited data on the changes of long-term epidemiology of imipenem resistance in A. baumannii bacteremia among pediatric ICU (PICU) patients.

Methods: A retrospective review was performed on patients with A. baumannii bacteremia in PICU of a tertiary teaching hospital from 2000 to 2016. Antimicrobial susceptibility tests, multilocus sequence typing (MLST), and polymerase chain reaction for antimicrobial resistance genes were performed for available isolates.

Results: A. baumannii bacteremia occurred in 27 patients; imipenem-sensitive A. baumannii (ISAB, n = 10, 37%) and imipenem-resistant A. baumannii (IRAB, n = 17, 63%). There was a clear shift in the antibiogram of A. baumannii during the study period. From 2000 to 2003, all isolates were ISAB (n = 6). From 2005 to 2008, both IRAB (n = 5) and ISAB (n = 4) were isolated. However, from 2009, all isolates were IRAB (n = 12). Ten isolates were available for additional test and confirmed as IRAB. MLST analysis showed that among 10 isolates, sequence type 138 was predominant (n = 7). All 10 isolates were positive for OXA-23-like and OXA-51-like carbapenemase. Of 27 bacteremia patients, 11 were male (41%), the median age at bacteremia onset was 5.2 years (range, 0-18.6 years). In 33% (9/27) of patients, A. baumannii was isolated from tracheal aspirate prior to development of bacteremia (median, 8 days; range, 5-124 days). The overall case-fatality rate was 63% (17/27) within 28 days. There was no statistical difference in the case fatality rate between ISAB and IRAB groups (50% vs. 71%; P = 0.422).

Conclusion: IRAB bacteremia causes serious threat in patients in PICU. Proactive infection control measures and antimicrobial stewardship are crucial for managing IRAB infection in PICU.

Keywords: Acinetobacter baumannii; Bacteremia; Pediatric Intensive Care Units.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Epidemiology of A. baumannii bacteremia in pediatric intensive care unit from 2000 to 2016.
Numbers shown in each bar refer to the isolate number. ISAB = imipenem-sensitive A. baumannii, IIAB = imipenem-intermediate-resistant A. baumannii, IRAB = imipenem-resistant A. baumannii, ND = not detected.
Fig. 2
Fig. 2. Survival curve of ISAB and IRAB group.
ISAB = imipenem-sensitive A. baumannii, IRAB = imipenem-resistant A. baumannii.
See this image and copyright information in PMC

References

    1. Lakshmi KS, Jayashree M, Singhi S, Ray P. Study of nosocomial primary bloodstream infections in a pediatric intensive care unit. J Trop Pediatr. 2007;53(2):87–92. - PubMed
    1. Le NK, Hf W, Vu PD, Khu DT, Le HT, Hoang BT, et al. High prevalence of hospital-acquired infections caused by Gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs: a multi-centre point prevalence survey. Medicine (Baltimore) 2016;95(27):e4099. - PMC - PubMed
    1. Lake JG, Weiner LM, Milstone AM, Saiman L, Magill SS, See I. Pathogen distribution and antimicrobial resistance among pediatric healthcare-associated infections reported to the National Healthcare Safety Network, 2011-2014. Infect Control Hosp Epidemiol. 2018;39(1):1–11. - PMC - PubMed
    1. Vila J, Bonomo RA. 46th Interscience Conference on Antimicrobial Agents and Chemotherapy. Future Microbiol. 2007;2(1):9–12. - PubMed
    1. Endo S, Yano H, Hirakata Y, Arai K, Kanamori H, Ogawa M, et al. Molecular epidemiology of carbapenem-non-susceptible Acinetobacter baumannii in Japan. J Antimicrob Chemother. 2012;67(7):1623–1626. - PubMed

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