Comparison of the Efficacy of Colistin Monotherapy and Colistin Combination Therapies in the Treatment of Nosocomial Pneumonia and Ventilator-Associated Pneumonia Caused by Acinetobacter baumannii

Objective. To investigate whether there was a difference in mortality; clinical response and bacterial eradication between colistin monotherapy and colistin combination therapies for the treatment of nosocomial pneumonia/ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii in a medical intensive care unit (ICU).Methods. This retrospective; observational and single-centre study included all patients who were in the medical ICU of Gazi University Medical Faculty Hospital and diagnosed with nosocomial pneumonia/VAP caused by A. baumannii between January 2009 and September 2014. Results. The median age of the 134 patients was 68 years and 53.3% were male. The most common causes of admission were respiratory insufficiency (66.7%) and sepsis/septic shock (54.8%). In patients with nosocomial pneumonia/VAP caused by A. baumannii; on median day 5 of admission; colistin monotherapy was used in 23 (21.6%) patients; a carbapenem combination was used in 80 (59.7%) patients; sulbactam-ampicillin combination was used in 42 (31.4%) patients; tigecycline combination was used in 26 (19.4%) patients; and sulbactam-cefoperazone combination was used in 17 (12.7%) patients. Median ICU stay of the patients was 15.5 days; and 112 (83.6%) patients died. Colistin monotherapy and combination therapies had no superiority over each other in clinical response for the treatment of A. baumannii-associated nosocomial pneumonia/VAP. Mortality was found to be higher in patients receiving the colistin-carbapenem combination (64.3% v. 36.4%; p=0.016). Discharge/day-of-death Sequential Organ Failure Assessment score (odds ratio (OR) 2.017; 95% confidence interval (CI) 1.330 - 3.061) and vasopressor use (OR 9.014; 95% CI 1.360 - 59.464) were independent risk factors for ICU mortality. Conclusion. Colistin monotherapy and combination therapies have no superiority over each other for clinical response in the treatment of nosocomial pneumonia/VAP caused by multidrug-resistant A. baumannii. Colistin-SAM was associated with improved microbiological eradication and colistin-carbapenem combination was associated with increased mortality

Multidrug resistant acinetobacter infection and their antimicrobial susceptibility pattern in a Nigerian tertiary hospital Icu

Background: Pelvic inflammatory disease refers to any infection in the female lower reproductive tract that spreads to the upper reproductive tract. The disease comprises a spectrum of inflammatory disorders of the upper female genital tract; including any combination of endometritis; salpingitis; tubo-ovarian abscess and pelvic peritonitis. PID is not a notifiable disease in most countries; so accurate statistics are not available. This situation is not in any way different here in Nigeria and more so in the Federal Capital Territory; Abuja where this research was conducted; there had never been any published report so far on PID. It therefore became pertinent that such studies be carried out to evaluate the bacterial organisms which may be associated with the disease in this part of Nigeria so that health care providers could take a better look at this affliction in women. Materials and Methods: Endocervical swabs totalling 100 were aseptically collected from patients with confirmed Pelvic Inflammatory Disease (PID); attending some hospitals in Abuja; Nigeria for detection of bacterial pathogens based on cultural and biochemical characterisation tests. Antibiogram was also conducted on the identified bacterial isolates. Results: Out of the 100 samples analysed; 43 yielded pure cultures of bacterial isolates; 2 yielded mixed cultures while no bacterial growths were recorded from the remaining 55 samples. Organisms encountered were Staphylococcus aureus (16); Escherichia coli (10); Streptococcus faecalis (8); Pseudomonas aeruginosa (4); Streptococcus pyogenes (3); Klebsiella pneumoniae (3); Proteus rettgeri (2) and Proteus mirabilis (1). The highest percentage occurrence of pathogenic isolates was observed in polygamous married patients (90). The age group most affected falls within the mean age 30.5 years (68) while the least affected group falls within the mean age 40.5 years (5). There was a significant difference in the acquisition of PID in relation to marital status (P 0.05). However there was no significant difference in the acquisition of the disease with respect to age (P 0.05). Antibiogram patterns of pathogenic isolates revealed varied resistance to most of the antibiotics employed. Cefotaxime (a new generation cephalosporin antibiotic) was established in this study as the best antimicrobial agent for treatment of PID due to Gram-positive and Gram-negative bacteria isolated from the women examined. Conclusion: In conclusion; Pelvic inflammatory disease is a major health problem in developed or developing countries of the world. PID is not a notifiable disease; as accurate statistics on disease prevalence are rarely available. There is therefore no doubt thousands of young women have salpingitis every year and their sheer number makes it an important health problem. PID hence can be said to be a very serious complication of sexually transmitted disease which should be critically and promptly handled by healthcare providers. The right type sample should be aseptically collected and be appropriately handled for laboratory investigation. Treatment of PID should be initiated as soon as the presumptive diagnosis has been made. Immediate administration of antibiotics has been effective in the long-term sequelae associated with PID; especially new generation antibiotics; such as cefotaxime as recorded in this study

Prevalence of Carbapenem Resistance Genes in Acinetobacter Baumannii Isolated From Clinical Specimens Obtained From an Academic Hospital in South Africa

Acinetobacter baumannii is an important cause of hospital-acquired infections. The occurrence of carbapenem resistance that is caused by the carbapenem-hydrolysing class D ?-lactamases and the metallo-?-lactamases (MBLs) limits the range of therapeutic alternatives in treating A. baumannii infections. In this study; two multiplex polymerase chain reactions were performed to screen for both carbapenem-hydrolysing class D ?-lactamases and MBL genes in 97 clinical isolates of A. baumannii. Oxacillinase (OXA)-51 had a prevalence of 83 (81/97); and OXA-23 had a prevalence of 59 (57/97). One isolate was positive for an MBL [Verona integron-encoded metallo ?-lactamases (VIM)]. Therefore; continuous surveillance and monitoring of A. baumannii is crucial because of the high prevalence of antibiotic resistance genes

Multidrug-Resistant Nosocomial Infections among Private Hospital Patients in the North West Province

"This article reports on severe clinical cases of nosocomial infections that were caused by multidrug-resistant (MDR) isolates of Acinetobacter baumannii and Pseudomonas aeruginosa in an intensive care unit (ICU). Globally; patients in ICUs have encountered an increasing emergence and spread of MDR pathogens. A retrospective case study was conducted to investigate the possible causes and occurrence of nosocomial infections linked to reported cases thereof in a private hospital in the North West province between December 2009 and August 2010. This followed an enquiry from a concerned community member about two patient deaths and a patient who was in the hospital's ICU between July and August 2010 with an infection by an unknown ""superbug"". Of the 24 adult patients who were admitted to the ICU in the study period; 22 presented with isolates of A. baumannii; one with P. aeruginosa; and one with presumed A. baumannii for which there was no laboratory test confirmation. Of those who were infected with A. baumannii; nine of the 22 died (a case fatality rate of 41). The patient with no laboratory test confirmation also died within seven days; while the patient who was infected with P. aeruginosa was still in hospital at the end of the study period (August 2010). The average length of stay in the hospital was 21.3 days. Six of the 24 patients (25) stayed longer than 30 days. A patient who was infected with P. aeruginosa stayed even longer. The most common cause of death among the ICU patients; notwithstanding other underlying conditions; was A. baumannii strain; which may have directly or indirectly contributed to the prolonged length of stay in hospital. It is possible that P. aeruginosa is a recent introduction to this ICU."