Acinetobacter baumannii and its antibiotics susceptibility in - - PowerPoint PPT Presentation

2015 AD 1436H

Acinetobacter baumannii and its antibiotics susceptibility in selected hospital's intensive care units in Sana'a city-Yemen

Ab Abdul ulra rahm hman Al Ali Moh

• hamm

mmed ed Za Zabad

• MSc. Medical Microbiology

Dr Dr. . An Anwa war K. Al . Al-Madhag hagi Associate Professor of Medical Microbiology Dr Dr. . Khaled ed A.

• A. Al

Al-Moy

• yed

ed Associate Professor of Medical Microbiology

Introduction

• Nosocomial infections is a cause of

increased morbidity and mortality, throughout the hospitals and particularly in the ICUs which harbor critically ill patients

• Acinetobacter baumannii is one of the

most important nosocomial pathogens in ICUs

Introduction

• A. baumannii is a Gram-negative non-

fermentative coccobacilli causing respiratory, blood stream, and surgical site infections.

• No published data are available about

Acinetobacter in Yemen, Thus this study is the first study that executed to determine it’s prevalence and antibiotics susceptibility patterns

Introduction

• Taxonomy of A. baumannii

Introduction

• Habitat and Transmission
• It is widely distributed in nature and are

found in soil and fresh water.

• It is a part of the bacterial flora of the skin

,oral cavity, URT and the GIT.

Introduction

• Sources of Spread in Hospitals
• The carriage rate of Acinetobacter on the

skin of hospitalized patients is higher than the community

• It was found persist in the environment

for up to 13 days after patient discharge

• It can survive on dry surfaces such as

mattresses and equipments

Introduction

Introduction

• Predisposing factors
• Include advanced age, surgery, previous

treatment with broad-spectrum antibiotics, use of invasive devices, burns, immunosuppression, Prolonged ICU stays, severe underlying diseases.

Introduction

• Pathogenesis of A. baumannii
• The precise mechanisms are unclear,
• not known to produce either diffusible

toxins or cytolysins

• Few

virulence factors have been identified; pilus biogenesis, iron uptake, quorum sensing and a Outer membrane proteins

Introduction

• Clinical manifestation
• Pneumonia
• Bacteraemia
• Urinary Tract Infections
• Skin and Soft-Tissue Infections
• Meningitis

Introduction

• Multi-drug-resistant A. baumannii
• There

is a global emergence

• f
• A. baumannii strains resistant to all β-

lactams, that illustrates the potential of this organism to up-regulate of innate resistance mechanisms and acquisition of foreign resistant genes

Introduction

• Resistance to β –lactams mechanisms:
• Expression of β –lactamases
• Outer-membrane permeability
• Modification of penicillin-binding proteins
• Increased activity of efflux pumps
• Resistance to Non- β -lactam Antibiotics
• Include aminoglycoside phosphotransferases,

acetyltransferases and adenyltransferases.

Introduction

• Control of A. baumannii infection
• Proper hand washing with antiseptic or

alcohol-based soaps and appropriate gloves use

• Use of antibacterial prophylaxis for

critically ill patients

• Monitoring trends in antimicrobial

resistance

Introduction

• Proper use of invasive procedures
• Isolation of infected patient.
• Environmental disinfection.
• Hyperaggressive cleaning during outbreak
• Appropriate antimicrobial use.
• Rapid discharge of patients from hospital

Introduction

Aims of the study

• This study was conducted to:

1. Estimate the prevalence of Acinetobacter baumannii in ICU's clinical and environmental samples. 2. Determine the antibiotics susceptibility patterns of isolates. 3. Study the risk factors contributed for its nosocomial infections.

Aims of the study

Methodology

• The study design
• It was a descriptive cross sectional study

involved ICUs in 3 hospitals, 2 public and 1 private (USTH, Al-Thawra Hospital and Al-Kuwait Hospital) in Sana'a city, Yemen during the period from October 2012 to September 2013.

Methodology

• Data collection
• Data was taken from each subject and

collected in a predesigned questionnaire.

• Specimen types and sampling
• Clinical specimens: Respiratory specimens

(tracheal aspirates) and blood were taken from study population

Methodology

• Specimens

collected under aseptic technique, respiratory aspirates taken after physiotherapy and before making bronchial

• washing. The blood specimens collected in

commercial aerobic bottle.

• Environmental samples:
• Sterile moist swabs were collected from

pillows, ventilators, tracheal tubes and central line catheters.

Methodology

• The sample size
• The sample size was calculated by Epi info
• It was 280 ICUs patients and 80 ICUs

environmental samples

• Isolation Method:
• Specimens directly inoculated on Leeds

Acinetobacter Medium and MacConkey agar aerobically at 370C overnight

Methodology

• On LAM it was produced pink colored,

small, smooth and convex colonies.

• On MacConkey it was produced white

colonies (non-lactose fermenter).

Methodology

• Characteristics of selected isolates:-
• Gram negative coccobacilli
• Oxidase negative
• Catalase positive
• No fermentation on Kligler's Iron Agar
• Negative reactions on SIM
• Positive on Citrate Agar and
• Negative on Urea Agar

Methodology

• Confirmation of the A. baumannii
• Growth on 440 C
• Analytical Profile Index API20 NE
• Antimicrobial Susceptibility Test:
• Disc Diffusion Test performed according

to standard procedure.

Methodology

Results

• Sex distribution of studied patients

Results

Male 57% Female 43%

• The age groups distribution of studied patients

Results

<19 yrs 8% 19-39 yrs 28% 40-69 yrs 50% >70 yrs 14%

Prevalence of A. baumannii among ICUs patients

p

Results

12.9% 1.4% 7.1%

2 4 6 8 10 12 14

Respiratory specimens Blood specimen Crude Prevalence

Series1

This result was similar with studies performed in Spain (8%) (Corbella et al, 2000), India (9.6%) (Joshi et al, 2006) and the Philippines (5%) (Chua and Alejandria, 2008).

This result was agreed with a study by Falagas et al, 2008 that reviewed 41 studies and found prevalence of Acinetobacter pneumonia in studies originating from Asia between 4-44%

• The association between age and A. baumannii

Results

Age groups/years

+ve culture OR CI

χ2

p No. % <19 n= 24 (0-5.9) 2.02 0.15 19-39 n= 78 6 7.7 1.12 (0.4-3.3) 0.05 0.82 40-69 n= 140 10 7.1 1.00 (0.4-2.7) 0.0 1.00 >69 n= 38 4

10.5 1.7 (0.4-5.7) 0.76 0.38

This was agreed with a study in Taiwan (Kuo et al, 2012) that found A. baumannii significantly higher with the age of 65 years and older

• The association between the length of stay for

ICU patients and of A. baumannii

Results

Duration (Days) +ve culture OR CI χ2 p No. % <7 days n= 198 6 3.03 0.15 (0.05-0.4) 17.2 0.0000 7-14 days n= 60 6 10.0 1.63 (0.5-4.8) 0.94 0.33 15-30days n= 18 8 44.4 16.7 (4.9-57) 40.3 0.0000 >30 days n= 4 0.0 (0-21) 0.31 0.57 This result disagreed with studies in South Korea ( Jung et al, 2010) and Turkey (Alp et al, 2009) that found no significant risk related to the duration of stay in ICU

The association between types of management procedures applied on patients and of A. baumannii

Results

Procedures +ve culture OR CI χ2 p No. % Mechanical ventilation n= 222 20 9 1.28 (1.2-1.3) 5.6 0.01 Central line n= 116 12 10.3 2.3 (0.8-6.3) 3.1 0.08 Tracheal tube n=118 18 15.2 14.4 (3.1-91)

• 20. 0.001

Nasogastric tube n= 216 18 8.3 2.8 (0.6-12) 2.0 0.266 This finding was similar to the result

• f a study in South

Korea that reported a significant risk with a statistical significant for tracheal tube

The association between number of invasive procedures applied on patients and A. baumannii

Results

Number of invasive procedures +ve culture OR CI χ2 p No. % One invasive procedure n= 138 6 4.3 0.42 (0.14- 1.2) 3.2 0.07 Two invasive procedure n= 66 4 6.0 0.0 (0.22- 2.7) 0.1 5 0.69 Three invasive procedure n=76 10 13.1 2.94 (1.1-8.1) 5.7 0.017 This result was agreed with a study in Brazil that found a significant correlation for the use of more than two invasive procedures (Prata-Rocha et al, 2012).

• The antibiotics susceptibility rates of 20 isolated A.

baumannii from ICUs patients

Results

Antibiotics S% I% R% Pipracillin-Tazobactam 5 95 Imepenem 10 90 Amikacin 10 90 Ticracillin 10 90 Doxycyclin 20 80 Cefepime 20 80 Colistin 100 Polymyxin B 100

These results agreed with studies in the Philippines (Chua and Alejandria, 2008), and Iran (Yadegarinia et al, 2013).

• Prevalence of A. baumannii in the ICUs

environmental samples at studied hospitals

Results

Types of samples

• No. of

samples

• No. of

isolates +ve rate Ventilators 20 1 5 Pillows 20 3 15 Tracheal tube 20 2 10 Central line 20 1 5 Total 80 7 8.8

All of the isolated A. baumannii from patients and ICUs environments were indistinguishable using both biotyping and antibiogram typing. This result was agreed with a study in the USA (Thom et al, 2011) that found a prevalence of A. baumannii in the environment of 9.8% and 85% of that isolates were genetically similar to the clinical isolates.

Conclusions and Recommendations

• The following can be concluded:
• Acinetobacter baumannii was common in

ICU's patients, especially in respiratory specimens rather than blood specimens and in the ICU environment.

• All Acinetobacter baumannii isolates

were multi-drug resistant in the form of more than two classes of antibiotics.

Conclusions

• Both clinical and environmental isolates

were indistinguishable regarding the biochemical and antibiogram characteristics.

• Patients who had longer ICU stay,

mechanical ventilation, tracheal tube and patients who had more than two invasive procedures were significantly at a higher risk of acquiring A. baumannii.

Conclusions

• The following can be recommended:
• Healthcare workers should be aware

about the local trends in nosocomial infection caused by A. baumannii and its susceptibility patterns.

• Strict adherence of infection control

policies, and contact precautions are needed.

Recommendations

• Rational antibiotic use, judicious use of

invasive procedures and continued antibiotic resistance surveillance through local guidelines.

• The study outcomes could be used as

benchmark rates as the incidence for further studies in future.

Recommendations