Document Type : Original Research

Authors

1 Dept. of Infectious Diseases and Tropical Medicine, Shahed University, Tehran, Iran

2 Dept. of Social Medicine, Shahed University, Tehran, Iran

Abstract

Background and Objective:Acinetobacter spp.a Gram-negative coccobacillus is increasingly reported as important cause of nosocomial infections. Multi-drug resistance (MDR) ofAcinetobacterspp., raises concerns over our ability to treat serious infections with these organisms. The aim of this study was to determine the frequency and associated risk factors for infections with MDR Acinetobacter spp. in ICU patients ofShahid Mostafa Khomeini Hospital, Tehran, Iran.
Patients and Methods:This descriptive-analytical andcross-sectional study was designed in 3 years period from April 2008 to March 2010 on 130 patients. For bacteriological analysis, sputum, blood, urine and wound specimens were used from patients within >48 hr after admission. Patient’s clinical and epidemiologic data were collected, from recordedfile, and correlated to Acinetobacter spp. infection. The data were analyzed using SPSS16 statistical software,chi-square, and Mann-Whitney test.
Results: The frequency of Acinetobacterspp. infection separately by years was 21.5%, 30.8% and 47.7% in 2008, 2009, 2010, respectively. All isolateswere resistant to carbnicillin, piperacillin, cefotaxime and cephalotin, 99.2% to ciprofloxacin, cotrimoxazole and chloramphenicol, 97.7% to imipenem, 95.4% to tetracycline and 91.5% to gentamicin. The highest sensitivity was to amikacin 14.6%.
Conclusion:Nosocomialinfections with Acinetobacter spp. during the three years, was a growing trend, and all isolates were MDR and highest susceptibility was to Amikacin. Most important risk factors wereincorrect diagnosis, inappropriate usage, doses, andtime of antibiotic therapy, inappropriate formulation of some antibiotics.
 

Keywords

  1. Akbari M, Davoudzade M, Rozbahani H, Tarhi M, Bayat A, Radsari E. Types of pathogens isolated from hospital staff gowns Martyrs Khorramabad tribes in 2003-2004 years. Lorestan University of Medical Sciences Journal 2005;7(2):11-6.
  2. Khosroshahi N, Sharifi M. Carbapenem resistant Acinetobacter strains isolated from patients in intensive care units and equipment of health centers in Qazvin in 2006-2007. Iranian Journal of Medical Microbiology 2007;3(1):33-8.
  3.  Acintobacter. Available at: http:// www.infectious disease. Louisiana.dhh.gov. Accessed 2008.
  4.  Bennani B, Selmani R, MahmoudM, Nejjari C, KanjaaN.Nosocomial pneumonia in mechanically ventilated patients: prospective study in intensive care unit of Fez university hospital. Saudi journal of Anaesthesia 2008;2(2):46-51.
  5.  WarehamD, BeanD, KhannaP, Hennessy E, Krahe D, Ely A, et al. Blood streaminfection due to Acintobacterspp: epidemiology, risk factor and impact of multi drug resistance. Eur J Clin Microbiol Infect Dis 2008;27(7):607-12.
  6.  Munoz-price LS, Weinstein RO. Acintobacter infection. N Engl J Med. 2008; 358(12):1271-81.
  7.  Mshana ST, Kamugisha ER, MiramboMA, Chakraborty TR, Lyamuya EL. Prevalenceof multi resistant gram negative organisms in a tertiary hospital in Mwanza,Tanzania. BMC Res Notes 2009; 2: 49-54.
  8.  Zarrilli RA, Crispino MA, BagattiniMA, Barretta EL, Di Popolo AN,Triassi MA, et al. Molecular epidemiology ofsequentialout breaks of A.baumanniiinICU shows theemergence ofcarbapenemresistance. J Clin Microbial 2004;42(3):946-53.
  9.  Patwardhan R, Dhakephalkar P, Niphadkar K, Chopade B. A Study ofnosocomialpathogenin ICU withspecialreference to multi resistant Acintobacterbaumanniiharbouringmultiple plasmids. Indian J Med Res 2008;128(2):178-87.
  10.  Jen shih MU, Yao lee NA, Chun lee HS, Ming chang CH, Jung wu CH, Ling chen PO, et al. Risk factor ofmulti drug resistance in nosocomialbacteremia due to Acinetobacter baumannii. J Microbiol ImmunolInfect 2008;41(2):118-23.
  11.  SunenshineRE, Wright MA, MaragakisLI, Harris AN, Song XI, HebdenJO, et al. Multi drug resistant Acintobacterinfection mortality rateandlength ofhospitalization. Emerg Infect Dis 2007; 13(1):97-103.
  12.  Ghorbanalizadegan M, Ranjbar R, Izadi M, Esmaili D, Ahmadi A, Goudarzi Z. Prevalence of Pseudomonas aeruginosa and Acinetobacter with multi drug resistance in patients admitted to hospital Baghiatollah. Ilam university of Medical Sciences Journal 2007;15(1):1-5.
  13.  Flanders S, Collard H, Saint S. Nosocomial pneumonia: state of the science. Am J Infect Control 2006;34(2):84-93.
  14. 14.  Van Looveren M, Goossens H.Antimicrobial resistance of Acinetobacter spp. in Europe. Clin Microbiol Infect 2004;10(8):684–704.
  15. Sadeghifard N, Ranjbar R,Ghasemi A, Pakzad I, Zaimi J,Zameri A, et al. Evaluation of drug resistant strains of Acinetobacter baumannii and other species isolated from three hospitals, Tehran. Ilam university of Medical Sciences Journal 2006;14(3):29-36.
  16. Basustaoglu AC, Kisa O, Sacilik SC. Epidemiological characterization of hospital-acquired Acinetobacter baumannii isolates from a 1500-bed teaching hospital by phenotypic and genotypic methods. J Hospital Infect 2001;47(3):246-49.
  17. Khaltabadi R, Moniri R, Shajari G, Nazem M,Mousavi G, Ghasemi A,et al.The pattern of antibiotic resistance and spread of antibiotic resistance genes in Acinetobacter strains isolated from Kashan. Faiz J Med Res 2009;12(4):60-6.
  18.  Hujer KM, Hujer AM, Hulten EA, Bajaksouzian S, Adams JM, Donskey CJ, et al. Analysis of antibiotic resistance genes in multi drug resistant Acintobacter spp. isolates from military and civilian patients treated at the Walter Reed Army Medical Center. Antimicrob Agent Chemother 2006;50(12): 4114-23.