Pan-resistant Acinetobacter Infection in Neonates in Karachi, Pakistan.

  • Ali Faisal Saleem Department of Pediatrics and Child health, Aga Khan University, Karachi
  • Imran Ahmed Department of Microbiology, Aga Khan University, Karachi
  • Fatima Mir Department of Pediatrics and Child health, Aga Khan University, Karachi
  • Syed Rehan Ali Department of Pediatrics and Child health, Aga Khan University, Karachi
  • Anita KM Zaidi Department of Pediatrics and Child health, Aga Khan University, Karachi
Keywords: Acinetobacter infection, neonate, mortality risk factors

Abstract

Background: Pan-resistant Acinetobacter infection has emerged as an important nosocomial pathogen in our inpatient neonates over the past few years.

Methodology: We performed a retrospective chart review during a five-year period (July 2003 - June 2008) of all neonates hospitalized in our neonatal intensive care unit (NICU) who developed Acinetobacter infection to identify mortality-associated risk factors in Acinetobacter neonatal infection.

Results: During the five-year study period, 122 cultures from 78 neonates grew Acinetobacter. Source sites of positive culture were in the following descending order: blood (n = 57), trachea (n = 55), tissue/wound/body fluids (n = 4), eye (n = 4), urine (n = 1), and cerebrospinal fluid (n = 1). Twenty-four (31%) patients had Acinetobacter isolated from more than one site. At the time of admission the mean age was 2.08 ± 4 days and mean weight was 1.77 ± 0.88 kg; 75% were premature. Pan-resistance (87/122; sensitive only to Polymyxin) was present in 71% of Acinetobacter isolates. Crude mortality rate of this cohort was 47%, while 70% of patients died within four days after positive Acinetobacter culture. We identified weight of less than 1 kg on admission (p 0.06, adjusted Odds Ratio (AOR) 1.53), gestational age 28 weeks or less (p 0.011, AOR 2.88), poor perfusion (p 0.007, AOR 2.4), thrombocytopenia (p 0.01; AOR 1.6) and metabolic acidosis (p 0.01; AOR 1.67) as predictors associated with poor outcome.   

Conclusion: Pan-resistant Acinetobacter infection is exceedingly fatal in newborns, particularly in premature and very low-birth weight neonates. Rational antibiotic use and vigilant infection control in NICUs are key to controlling multi-drug resistant Acinetobacter infection and improving clinical outcome.

Author Biographies

Ali Faisal Saleem, Department of Pediatrics and Child health, Aga Khan University, Karachi

Resident Pediatrics,

Department of Pediatrics and Child health,

The Aga Khan University Hospital, Karachi, Pakistan

Imran Ahmed, Department of Microbiology, Aga Khan University, Karachi

Resident Microbiology,

Department of Pathology and Microbiology

Fatima Mir, Department of Pediatrics and Child health, Aga Khan University, Karachi

Fellow Pediatrics Infectious Disease

Department of Pediatrics and Child Health.

The Aga Khan University Hospital, Karachi, Pakistan


(Dr. Fatima Mir was supported by Grant Number 1 D43 TW007585-01 from the National Institute of Health’s Fogarty International Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.”)

Syed Rehan Ali, Department of Pediatrics and Child health, Aga Khan University, Karachi

Assistant Professor and Consultant in Neonatal Medicine
Department of Pediatrics and Child Health

The Aga Khan University Hospital, Karachi, Pakistan

Anita KM Zaidi, Department of Pediatrics and Child health, Aga Khan University, Karachi

The Abdul Sultan Jamal Professor of Pediatrics and Child Health, and Microbiology
Director of Research

Department of Pediatrics and Child Health.

The Aga Khan University Hospital, Karachi, Pakistan

Published
2009-11-05
How to Cite
1.
Saleem AF, Ahmed I, Mir F, Ali SR, Zaidi AK (2009) Pan-resistant Acinetobacter Infection in Neonates in Karachi, Pakistan. J Infect Dev Ctries 4:030-037. doi: 10.3855/jidc.533
Section
Original Articles