Risk factors for acquiring Acinetobacter baumannii infection in the intensive care unit: experience from a Moroccan hospital

  1. Elmostafa Benaissa
  2. Elmehdi Belouad
  3. Adil Maleb
  4. Mostafa Elouennass

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Abstract

Introduction. Acinetobacter species are non-fermenting and ubiquitous Gram-negative coccobacilli, which in recent years have become the leading cause of healthcare-associated infections worldwide. Our objective here was to study the epidemiology and risk factors associated with Acinetobacter baumannii infections in the intensive care unit (ICU).

Methods. This retrospective case-control study was conducted collaboratively between the Medical Bacteriology Department and the two ICUs of the Military Hospital of Instruction Mohammed V-Rabat over a 3 month period.

Results. We included 180 patients, of whom 60 had A. baumannii infection. We observed a male predominance in both matched groups, with a sex ratio of 1.6. The median age was 67 years [interquartile range (IQR) 59.5–77]. The median length of stay in the ICU before infection was 8.5 days (IQR 5–14). Multivariate logistic regression analysis identified the risk factors statistically associated with A. baumannii infection at the ICU level as follows: duration of invasive procedures >7 days [odds ratio (OR)=1.02], parenteral nutrition (OR=3.514), mechanical ventilation (OR=3.024), imipenem (OR=18.72), colistin (OR=5.645), probabilistic antibiotic therapy >4 days (OR=9.063) and neoplastic pathology (OR=5.727).

Conclusion. Based on our results, it can be inferred that shortening the duration of stay in the resuscitation setting, implementing rational use of medical devices and optimizing antibiotic therapy could decrease the incidence of these infections.

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  1. Version published to 10.1099/acmi.0.000637.v3 on Access Microbiology
  3. Version published to 10.1099/acmi.0.000637.v2 on Access Microbiology
  5. Access Microbiology

    Comments to Author

    This is a well written manuscript and makes an original contribution. However, few changes are recommended to be considered by the author. 1. In abstract introduction, colon should be placed instead of semi-colon. 2. It should be mentioned as multidrug resistant and not as multi-resistant (e.g. in line no. 69). 3. Once the organism has been named fully, afterwards it should be mentioned as A. baumanii only. 4. Line no. 88 should be in continuation with above paragraph i.e. line no. 87. 5. In line number 71, Intensive care unit should be written as ICU also in bracket as it has been used as ICU in line no. 87. Similarly at other places also it should be mentioned as ICU. 6. In line no. 133, Microsoft excel should not be in bracket. 7. Figure 1 is showing resistance profile so in legend also it should be resistance profile and not susceptibility profile. 8. Please give space between "care and" in line no. 187. 9. Reference required of meta-analysis study mentioned in line nos. 233-236. 10. There is no data revealed about the immune status of patients as it could also be a risk factor for causing infections among ICU patients. 11. Some light should be focused on extensively drug resistant (XDR) and pan drug resistant (PDR) A. baumanii strains also in this study. 12. Role of healthcare workers can also be discussed as one mode of transmission of multi drug resistant strains. Other risk factors which could be considered or mentioned as hospital infection control policies like hand hygiene, regular cleaning of ICUs, entry and exit of attendants. 13. In conclusion, it should be suggested that a local antibiogram database is required for the hospital.

    Please rate the manuscript for methodological rigour

    Good

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  6. Access Microbiology

    Comments to Author

    The manuscript discusses about an important pathogen, Acinetobacter baumannii, which is more commonly a multi-drug resistant organism. Growth of this pathogen in an ICU setting and risk factors associated with it, is a relevant issue that needs to be highlighted and discussed. The authors have presented the manuscript well, the results and tables are nicely presented. Discussion part is also well-written, although there are a few grammatical errors here and there. Overall, the manuscript is good and can be accepted.

    Please rate the manuscript for methodological rigour

    Very good

    Please rate the quality of the presentation and structure of the manuscript

    Very good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  7. Version published to 10.1099/acmi.0.000637.v1 on Access Microbiology