engleski

Invasive Acinetobacter baumannii infections in paediatric infectious disease intensive care unit

Background: Acinetobacter baumannii has become an important cause of nosocomial infections and has displayed increasing antimicrobial resistance over the last decade. The goal of this study was to examine the occurrence, clinical presentation, risk factors, antimicrobial susceptibility and mortality of invasive A. baumannii infections in pediatric infectious diseases intensive care unit (PICU). Materials/methods: We conducted a retrospective cohort study that included patients treated for invasive A. baumannii infection in PICU at the University Hospital for Infectious Diseases in Zagreb, Croatia, in a 9-year period (2010 – 2019). Results: Seven children (eight infection episodes) ; 4 girls and 3 boys with median age 14 months (range 4 months – 13 years) were treated during the studied period. They all had hospitally acquired A. baumanii infection (6 in other hospitals and 2 in our PICU). All patients had some predisposing factors for invasive infection (ventriculo-peritoneal drainage in 4/7 (57.1%), combined heart defect in 1/7 (14.3%), tracheostomy in 1/7 (14.3%) and systemic erythematous lupus in 1/7 (14.3%)). Acinetobacter was isolated mainly from cerebrospinal fluid (5/8, 62.5%) and blood cultures (3/8, 37.5%), while 3 patients (37.5%) had concomitant isolate from tracheal aspirates. 5 infection episodes (62.5%) were postoperative shunt-meningitis with bacteria isolated from cerebrospinal fluid. The average CSF cell count was 7168 (range 240-17920) cells in 3mm3. One patient had concomitant pneumonia. Patients were treated with meropenem (4 patients) and colistin (1 patient) ; two patients received intrathecal amikacin. 3 patients had sepsis (37.5% infection episodes), treated with ampicillin- sulbactam (2 patients) and meropenem (1 patient). Two of them had external source (central venous catheter) and one had origin in pneumonia/tracheal colonization (due to chronic tracheostoma). Four isolates (50%) had good antimicrobial susceptibility, 3 (37.5%) were susceptible only to ampicilin- sulbactam and colistin while one (14.3%) was susceptible solely to colistin. Mortality rate was 50% (2 patients with sepsis and 2 with shunt-meningitis died). Conclusions: Acinetobacter baumanii predominantly causes severe invasive infections in conditioned pediatric patients with exposure to hospital enviRoment. Although Acinetobacter infections are not common in our PICU, the isolation of this nosocomial pathogen should be of particular concern due to high antimicrobial resistance rate and significant mortality.

acinetobacter baumannii ; paediatric infectious ; intensive care unit

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