Jean Uwingabiye1, Abdelhay Lemnouer2, Sabina Baidoo1, Mohammed Frikh2, Jalal Kasouati2, Adil Maleb1, Yassine Benlahlou1, Fatna Bssaibis3, Albert Mbayo4, Nawfal Doghmi4, Khalil Abouelalaa4, Abdelouahed Baite4, Azeddine Ibrahimi5, Mostafa Elouennass2. 1. PharmD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco. 2. MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco. 3. Msc, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco. 4. MD, Department of Intensive Care Units, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco. 5. PhD, Medical Biotechnology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco.
Abstract
INTRODUCTION: The objective of this study was to examine the epidemiology, risk factors and outcome associated with Acinetobacter baumannii infections in the intensive care units (ICUs) in a Moroccan teaching hospital. METHODS: This is a matched case-control study conducted as a joint collaboration between the clinical Bacteriology department and the two ICUs of Mohammed V Military Teaching Hospital from January 2015 to July 2016. RESULTS: Among 964 patients hospitalized in the ICUs, 81 (8.4%) developed A. baumannii infections. Multivariate logistic regression analysis identified the following independent risk factors for ICU-acquired A. baumannii infections: ICU stay ≥14 days (odds ratio (OR)=6.4), prior use of central venous catheters (OR=18), prior use of mechanical ventilation (OR=9.5), duration of invasive procedures ≥7 days (OR=7.8), previous exposure to imipenem (OR=9.1), previous exposure to amikacin (OR=5.2), previous exposure to antibiotic polytherapy (OR=11.8) and previous exposure to corticotherapy (OR=5). On the other hand, the admission for post-operative care was identified as a protective factor. The crude mortality in patients with A. baumannii infection was 74.1%. Multivariate analysis showed that septic shock (OR=19.2) and older age (≥65 years) (OR=4.9) were significantly associated to mortality risk in patients with A. baumannii infection. CONCLUSION: Our results show that shortening the ICU stay, rational use of medical devices and optimizing antimicrobial therapy could reduce the incidence of these infections. Elderly patients and those with septic shock have a poor prognosis. These findings highlight the need for focusing on the high-risk patients to prevent these infections and improve clinical outcome.
INTRODUCTION: The objective of this study was to examine the epidemiology, risk factors and outcome associated with Acinetobacter baumannii infections in the intensive care units (ICUs) in a Moroccan teaching hospital. METHODS: This is a matched case-control study conducted as a joint collaboration between the clinical Bacteriology department and the two ICUs of Mohammed V Military Teaching Hospital from January 2015 to July 2016. RESULTS: Among 964 patients hospitalized in the ICUs, 81 (8.4%) developed A. baumannii infections. Multivariate logistic regression analysis identified the following independent risk factors for ICU-acquired A. baumannii infections: ICU stay ≥14 days (odds ratio (OR)=6.4), prior use of central venous catheters (OR=18), prior use of mechanical ventilation (OR=9.5), duration of invasive procedures ≥7 days (OR=7.8), previous exposure to imipenem (OR=9.1), previous exposure to amikacin (OR=5.2), previous exposure to antibiotic polytherapy (OR=11.8) and previous exposure to corticotherapy (OR=5). On the other hand, the admission for post-operative care was identified as a protective factor. The crude mortality in patients with A. baumannii infection was 74.1%. Multivariate analysis showed that septic shock (OR=19.2) and older age (≥65 years) (OR=4.9) were significantly associated to mortality risk in patients with A. baumannii infection. CONCLUSION: Our results show that shortening the ICU stay, rational use of medical devices and optimizing antimicrobial therapy could reduce the incidence of these infections. Elderly patients and those with septic shock have a poor prognosis. These findings highlight the need for focusing on the high-risk patients to prevent these infections and improve clinical outcome.
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