DISCUSION
Epidemiological surveillance of bacterial infection and resistance to
antibiotics are essential for awareness creation, implementation of
control measures and effective management of infections. In developing
countries as in Sub-Saharan Africa, insufficient measures to prevent
infections caused by multidrug-resistant bacteria cause an increase in
mortality and morbidity [8, 9]. Cardiac surgical patients may show
diversity from other surgical and medical ICU patients
The clinical management of intensive care unit (ICU) patients with
infections has been complicated by the emergence and spread of extremely
drug-resistant (XDR) Acinetobacter baumannii strains [8]. Infections
caused by multidrug resistant Acinetobacter baumannii strains; may cause
life-threatening poor patient outcomes such as ventilator-related
pneumonia, sepsis, urinary tract infections, and skin and soft tissue
disorders [10, 11]. In our study, the infection affected more of the
respiratory system (78.4%). In decreasing rates; surgical site, blood
and urinary system were isolated AB.
The pediatric and geriatric patients are usually more disposed to
infections due to their immune status. The advancing age are commonly
associated with risk factors including reduced immunity, co-morbid
diseases such as chronic heart diseases, diabetes mellitus, neurogenic
bladder [12, 13] whilst in infants, lack of fully developed
immunity, malnutrition as well as inadequate hygiene [14] put them
at greater risk of infections. In a study conducted in Ghana, urinary
tract infection was 31% [15].Respiratory system diseases,DM,renal
diseases,HL,HT were in our patients risk factors.
MDR A. baumannii is a problematic, multidrug-resistant pathogen
identifed in healthcare settings worldwide, especially in ICUs [16].
A. baumannii has a notable ability to capture and express resistance
genes. All resistance mechanisms including target modifcation, efux pump
expression, and enzymatic inactivation have been described in A.
baumannii [17].
A. baumannii is considered as an opportunistic pathogen that can survive
in austere conditions. It is responsible of an increasing rate of severe
nosocomial infections. They affect especially immunocompromised
patients, exposed to prolonged stays in ICUs and having a previous
exposure to antibiotics; carbapenems and 3rd generation cephalosporins
are the most involved, followed by fluoroquinolones, aminoglycosides and
metronidazole (18, 19). Other factors that are associated with the
occurrence of A. baumannii bacteremia are: assisted ventilation, central
catheterization, urinary catheters, and nasogastric probes (20). All the
patients included in the study had these risk factors
Katsaragakis et al. (21) investigated the mortality pre-determinants of
patients with A. baumannii infection in a prospective study of 680
patients with surgical ICU. This study showed that the APACHE II score
is one of the predisposing factors affecting mortality due to A.
baumannii infection. Another study by Pirates et al. (22) showed that
the APACHE II score is an independent risk factor when considering the
mortality of the patients present at the time of an A. baumannii
outbreak in the ICU.
In other studies, age, severity of the underlying disease,
immunosuppression, recent surgery, mechanical ventilation, septic shock,
thrombocytopenia,low serum albumin, multi drug resistance, inappropriate
antimicrobial therapy, and invasive procedures such as central venous
catheterization, urinary catheterization, nasogastric tube placement,
and pulmonary catheterization have been found as factors affectingA
baumannii infection-relatedmortality in univariate analysis
(23,25,26,29,31). In multivariate analysis, age, immunosuppression,
APACHE II score, multiresistance, mechanical ventilation, recent
surgery, septic shock, and respiratory and renal failure have been
identified as factors independently correlated with mortality(23,25,29).
We have reached similar findings in these studies
Disseminated intravascular coagulation, APACHE II score, inappropriate
antimicrobial treatment, and neutropenia have also been reported as
predictors of A baumannii bacteremia mortality(24,31). Furthermore,
APACHE II score, SOFA score, and inadequate empirical antibiotic therapy
have been identified as prognostic factors for ventilator-associated A
baumannii pneumonia mortality(32,33). Additionally, age and acute renal
failure have been identified as mortality predictors of multiresistant
gram-negative bacteria infections(34) and thrombocytopenia as predictor
of mortality in ICU patients.