Carbapenem-resistant Acinetobacter baumannii infections: Antimicrobial resistance patterns and risk factors for acquisition in a Kenyan intensive care unit

Abstract

Multidrug-resistant (MDR) Acinetobacter baumannii (AB), especially carbapenem-resistant (CR) strains, presents a significant challenge in intensive care units but surveillance data in many resource-constrained countries is inadequate. Here, we determined the prevalence of MDRAB and risk factors for infection and mortality in ICU-admitted patients. A cross-sectional study among 132 consecutive patients between July 2019 and July 2020, with infected patients followed for 30 day from sample collection to ICU discharge/death. Blood, urine, and tracheal aspirates samples were processed following the standard bacteriological procedures. Isolates identity and antimicrobial susceptibility were elucidated by VITEK 2 Compact system. The prevalence of MDRAB was 22.7% (30/132), mostly from urine samples (12.1%, 16/132), and dominated by CRAB (83.3%) that were colistin-nonresistant and exhibited high multiple antibiotic resistance indices, ranging from 0.64 to 0.91. Risk factors for infection were occupation (aOR =4.41, p=0.016) and interhospital referral status (aOR =0.14, p =0.001). ICU mortality was 20% (6/30). Our findings underpin the need for strict adherence to and evaluation of infection prevention and control, and continuous surveillance of CRAB in ICU, especially among the risk groups, in the current study setting and beyond.