High lethality rate of carbapenem-resistant <i>Acinetobacter baumannii</i> in Intensive Care Units of a Brazilian hospital: An epidemiologic surveillance study

Kurihara, Mariana Neri Lucas; Sales, Romário Oliveira de; Silva, Késia Esther da; Silva, Gerlaine Damasceno; Mansano, Maria Carolina Tazinazzo; Mahmoud, Fuad Fayez; Simionatto, Simone

doi:10.1590/0037-8682-0529-2021

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Revista da Sociedade Brasileira de Medicina Tropical

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Sumário

Short Communication • Rev. Soc. Bras. Med. Trop. 55 • 2022 • https://doi.org/10.1590/0037-8682-0529-2021 copy

High lethality rate of carbapenem-resistant Acinetobacter baumannii in Intensive Care Units of a Brazilian hospital: An epidemiologic surveillance study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

Carbapenem-resistant Acinetobacter baumannii (CRAB) is a growing threat to public health.

Methods:

A 3-year retrospective study was conducted to evaluate the prevalence and lethality of multidrug-resistant (MDR) A. baumannii isolated from Brazilian patients.

Results:

In this study, 219 Acinetobacter baumannii isolates were identified, of which 70.8% (155/219) were isolated from patients hospitalized in intensive care units. Of these, 57.4% (n = 89/155) were assessed, of which 92.1% (82/89) were carbapenem-resistant, and 49 were classified as infected. The lethality rate was 79.6% (39/49).

Conclusions:

We highlight the need of an effective epidemiological surveillance measure to contain the dissemination of CRAB in the hospital environment.

Keywords:
Acinetobacter baumannii; Carbapenem-resistant; Epidemiology; Surveillance; Lethality

Variables	Validated cases	Nº
		2015	2016	2017
Records analyzed	89 (100%)	37 (41.6%)	22 (24.7%)	30 (33,7%)
Resistance profile
Susceptible	7 (7.9%)	5 (13.5%)	2 (9.1%)	-
Resistant	82 (92.1%)	32 (86.5%)	20 (90.9%)	30 (100%)
Sex
Man	48 (58.5%)	15 (46.9%)	14 (70%)	19 (63,3%)
Woman	34 (41.5%)	17 (53.1%)	6 (30%)	11 (36,7%)
Age
More than 60 years	43 (52.4%)	18 (56.2%)	9 (45%)	16 (53,3%)
Among 18 to 59 years	34 (41.5%)	14 (43.8%)	8 (40%)	12 (40%)
Among 0 to 18 years	5 (6,1%)	-	3 (15%)	2 (6,7%)
Ward
Adult Intensive Care Unit A	35 (42.7%)	14 (43.7%)	10 (50%)	11 (36,6%)
Adult Intensive Care Unit B	42 (51.2%)	18 (56.3%)	7 (35%)	17 (56,7%)
Neonatal Intensive Care Unit	2 (2.4%)	-	2 (10%)	-
Pediatric Intensive Care Unit	3 (3.7%)	-	1 (5%)	2 (6,7%)
Isolated material
Tracheal aspirate	39 (47.6%)	14 (43.8%)	13 (65%)	12 (40%)
Catheter tip	7 (8.6%)	1 (3.1%)	3 (15%)	3 (10%)
Swab	26 (31.7%)	15 (46.9%)	-	11(36.7%)
Blood culture	6 (7.3%)	1 (3.1%)	2 (10%)	3 (10%)
Uroculture	2 (2.4%)	-	1 (5%)	1 (3.3%)
Eschar	1 (1.2%)	1 (3.1%)	-	-
Vaginal secretion	1 (1.2%)	-	1 (5%)	-
Comorbity
Pneumonia	52 (63.4%)	21 (65.7%)	15 (75%)	16 (53.3%)
Systemic arterial hypertension	36 (43.9%)	17 (53.1%)	7 (35%)	12 (40%)
Ischemic vascular stroke	12 (14.6%)	7 (21.9%)	3 (15%)	2 (6.7%)
HIV-AIDS	7 (8.5%)	2 (6.2%)	2 (10%)	3 (10%)
Diabetes mellitus	35 (42.7%)	14 (43.8%)	7 (35%)	14 (46.7%)
Sepsis	23 (28%)	7 (21.9%)	6 (30%)	10 (33.3%)
Pulmonary sepsis	20 (24.4%)	10 (31.3%)	4 (20%)	6 (20%)
H1N1 influenza	4 (4.9%)	1 (3.1%)	3 (15%)	-
Tuberculosis	3 (3.7%)	-	-	3 (10%)
Acute renal failure	28 (34.1%)	13 (40.6%)	5 (25%)	10 (33.3%)
Congestive heart failure	7 (8.5%)	5 (15.6%)	1 (5%)	1 (3.3%)
COPD	10 (12.2%)	5 (15.6%)	3 (15%)	2 (6.7%)
Acute respiratory insufficiency	17 (20.7%)	6 (18.8%)	3 (15%)	8 (26.7%)
Invasive Procedures
Mechanical ventilation	71 (86.6%)	26 (81.2%)	20 (100%)	25 (83.3%)
NP/VDP	72 (87.8%)	27 (84.4%)	18 (90%)	27 (90%)
Tracheostomy	30 (36.6%)	10 (31.3%)	7 (35%)	13 (43.3%)
Central venous access	46 (56.1%)	18 (56.3%)	12 (60%)	16 (53.3%)
Surgery	17 (20.7%)	3 (9.4%)	10 (50%)	4 (13.3%)
Hemodialysis	21 (25.6%)	5 (15.6%)	5 (25%)	11 (36.7%)

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[1] Corresponding author: Dr. Simone Simionatto e-mail:simonesimionatto@ufgd.edu.br