Acinetobacter infection in neurosurgical intensive care patients.

ABSTRACT

BACKGROUND: This study was performed to analyse the incidence of Acinetobacter infections in neurosurgical patients in the postoperative period. METHODS: Two thousand three hundred and twenty postoperative cranial neurosurgical intensive care unit (ICU) patients were studied from March 1995 to August 1996; 419 patients had a variety of infections and 42 patients had multiple infections. Acinetobacter was isolated in 103 patients (24.6% of total patients infected and 4.4% of total patients analysed). Statistical analyses were performed to identify the risk factors, antibiotic sensitivity and outcome of therapy of Acinetobacter infection. RESULTS: Acinetobacter infection was not significantly related to the length of hospital stay prior to surgery but was related significantly to the length of stay in the ICU after surgery. Acinetobacter was isolated from sputum/tracheal secretions in 47/103 (45.6%), followed by cerebrospinal fluid [24/103 (23.3%)], urine [15/103 (14.56%)] and blood [15/103 (11.65%)]. Acinetobacter infection was present in 54 (3.21%) of 1680 patients who had undergone routine/elective surgery and in 49 (7.66%) of 640 patients following emergency surgery. Elective/supportive ventilation for > 5 days, external ventricular cerebrospinal fluid drainage for > 5 days, intracranial pressure monitoring and prolonged indwelling Foley's urinary catheter during the perioperative period were independent risk factors (p < 0.005). Acinetobacter isolated from sputum/tracheal secretions were mostly sensitive to amikacin, cefotaxime and ceftriaxone; while those grown from the cerebrospinal fluid were more often sensitive to ciprofloxacin, amikacin and netilmycin. Twenty-four patients succumbed to Acinetobacter infection; in 11 of these patients the organism was resistant to all antibiotics. CONCLUSION: Acinetobacter is an important nosocomial infection in neurosurgical intensive care patients.