Clinical and molecular characteristics of OXA-72-producing Acinetobacter baumannii ST636 outbreak at a neonatal intensive care unit in Serbia.

AIM: To describe an Acinetobacter baumannii outbreak among preterm neonates in a neonatal intensive care unit (NICU) in Serbia. METHODS: A case-control study was conducted in the NICU at the Institute of Neonatology, Belgrade, Serbia. The case definition of A. baumannii bloodstream infection (BSI) was blood culture confirmation of systemic infection. Isolation, identification and susceptibility testing were performed using conventional methods. Molecular characterization of isolates included resistance gene detection, pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing. Outcomes and clinical and demographic data were obtained from patients' medical records. An infection prevention team was formed and infection control interventions were implemented. FINDINGS: During the outbreak period (May-July 2018), there were 13 cases of A. baumannii BSI among 82 hospitalized neonates. All A. baumannii strains were carbapenem resistant and susceptible to colistin. Molecular characterization of the isolates revealed that they harboured blaOXA66 and blaOXA72 beta-lactamases and belonged to sequence type 636, while the PFGE pattern indicated clonal spread. Lower gestational age, lower Apgar score, vaginal delivery and mechanical ventilation were risk factors for A. baumannii infection. Four patients died, eight patients were treated successfully with colistin, and one patient with sepsis and meningitis on dual ampicillin-sulbactam and colistin therapy recovered with sequelae. The outbreak was eventually controlled by reinforcement of the infection control measures based on a multi-tiered interventional approach. CONCLUSION: This is the first description of an outbreak of BSI among preterm neonates caused by A. baumannii blaOXA66/blaOXA72/ST636 in Serbia.

[The influence of protein and phosphorous restricted diet supplemented with essential aminoacids (EAA) and their alpha-keto-analogues (KAA) on nutritional status of children with chronic renal failure (CRF)]. / Uticaj normoenergetske, neselekcione niskoproteinske dijete na stanje uhranjenosti dece s hronicnom insuficijencijom bubrega.

The purpose of the study was to establish the influence of protein restricted diet supplemented with EAA/KAA on nutritional status of children with CRF. Seven childredn (four girls and three boys), aged from 7 years and eight months to 14 years and two months, with glomerular filtration rate of 42.6-9.2 ml/min/1.73 m2 and proteinuria of 0.025-1.125 g/24 h, who were on conservative treatment and who lived at home, were observed for six months. In prescribing energy value and protein intake WHO recommendations were used for healthly children (age for height). Through food 80-90% of energy and 80-85% of protein needs were provided. The remaining energy and proteins were provided by glucodextrin and EAA/KAA supplements respectevely. Average daily phosphorous intake amounted to about 550-800 mg. The obtained results showed that stunting and kwashiorkor like aminoacid disbalance were the prominent nutritional problems. This dietary regimen had a beneficial effect on all studied parameters. especially on height standard deviation score which increased from 1.71 +/- 2.6 to 1.5 +/- 4.3 (t = 2.809, p < 0.05); total essential/nonessential aminoacid score increased from 0.38 +/- 0.2 to 0.56 +/- 0.2 (t = 2.763, p < 0.05). The ratio between plasma concentration of four nonessential (glycine+serinet glutamine+taurine) to four essential (leucine+isoleucine+valine+methionine) amino acids decreased from 3.82 +/- 1.2 to 2.7 +/- 0.4 (t = 2.528, p < 0.05). Lymphocyte count increased from 1.809 x 10(9) +/- 0.268 x 10(9)/l to 2.314 x 10(9) +/- 0.922 x 10(9)/l (t = 2.431, p < 0.05). No significant changes were found in the values of relative body weight, arm circumpherence, triceps skinfold thickness, total plasma protein, albumin, transferine, complement C3 and plasma valin/glycin and phenylalanine/thyrosine ratio. It should be noted that the significant changes were not found in the results of these latter anthropometric biochemical parameters in relation to their primary almost insignificant values.