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.