Risk factors and clinical outcomes of infections caused by acinetobacter spp. in children: Results of a 5 year study

Abstract

Objective: The number of infections caused by microorganisms of the genus Acinetobacter has increased in recent years. The aim of this study was to evaluate the risk factors and clinical outcomes associated with multidrug resistant (MDR) Acinetobacter infections in children and to define the predisposing factors associated with Acinetobacter spp. infection related mortality.Material and Method: We conducted a case-control study between January 1, 2004 and December 31, 2008 at the Uludag University Pediatric Clinic. Multidrug resistance was defined as resistance to all antibiotics apart from colistin. All patients with MDR Acinetobacter spp. infections were compared to patients with non-MDR Acinetobacter spp. infections. Risk factors analyzed included prior antibiotic use, underlying diseases, invasive medical devices, and other demographic characteristics.Results: Acinetobacter spp. infections were diagnosed in 95 of the 8879 patients hospitalized in our center between January 1, 2004 and December 31, 2008 (overall incidence, 10.6 per 1,000 admissions). The mean age of patients was 62.1+ 61.2 months (15 days-18 years) and 56% were male. The prevalence of MDR isolates among Acinetobacter spp. was found to be 33.6%. In this study, risk factors for MDR Acinetobacter spp. infections included prolonged hospitalization and prolonged exposure to broad-spectrum antibiotics (p< 0.05). The mortality rate of Acinetobacter spp. infection was found to be 26.3%. Predisposing factors associated with mortality were pediatric intensive care unit stay, male gender, ventilator associated pneumonia, presence of immunodeficiency or renal disease, presence of mechanical ventilation and MDR Acinetobacter spp. infections (p< 0.05).Conclusion: In this study, the prevalence of multidrugresistant isolates among Acinetobacter spp. was 33.6 %. The mortality (50%) for patients in the MDR group was significantly higher than the mortality for patients in the non-MDR group (11%) (p< 0.05).