Early detection of a possible multidrug-resistant Acinetobacter baumannii outbreak in the local hospital setting by using random amplified polymorphism DNA-polymerase chain reaction (RAPD-PCR), oxacillinase gene profiles, and antibiograms.

Background and Objectives: Detecting the source of a potential outbreak of multidrug resistant (MDR) Acinetobacter baumannii is necessary to be investigated. This study aimed to detect the possibility of A. baumannii outbreak in a hospital setting using a combination of random amplified polymorphism DNA-polymerase chain reaction (RAPD-PCR), antibiograms, and the presence of oxacillinase genes. Materials and Methods: The antibiogram of 31 clinical isolates and six environmental isolates of A. baumannii were determined by Vitek® 2 Compact. Oxacillinase genes (OXA-23, -24, -51, and -58) were detected by PCR, and RAPD-PCR was conducted using DAF-4 and ERIC-2 primers. The Similarity Index and dendrogram were generated using GelJ v2.3 software. Results: The antibiograms showed that all MDR A. baumannii isolates has very limited susceptibility to cephalosporins, but mostly susceptible to tigecycline. All isolates were positive for bla OXA-51-like gene, thirty-two of 37 total isolates (86.5%) were positive for bla OXA-23-like gene, and none were positive for bla OXA-24-like and bla OXA-58-like genes. RAPD-PCR showed that the DAF-4 primer on average had more band visualization and lower Similarity Index's variation compared to the ERIC-2. The discriminatory power of DAF-4 was 0.906. There was a significant correlation between the DAF-4 dendrogram pattern with the antibiogram (r=0.494, p<0.001) and the presence of bla OXA-23-like gene (r=0.634, p<0.001) from all ICU A isolates. Six out of fourteen ICU A isolates belonged to the same cluster with >95% Similarity Index, while one clinical isolate having an identical dendrogram and antibiogram pattern with an environmental isolate within this cluster. Conclusion: There is a high probability of MDR A. baumannii outbreak within ICU A detected by multiple analysis of RAPD-PCR, antibiogram and the bla OXA-23-like gene profiles. This combinatorial approach is conceivable to mitigate possible outbreak situations of A. baumannii in the local hospital without sophisticated microbiology laboratory.

Role of Procalcitonin in Predicting Mortality and Organ Dysfunction at Intensive Care Admission.

Objective: To assess the prognostic utility of procalcitonin (PCT) in high-risk sepsis patients. Methods: A retrospective cohort study was conducted with the inclusion of all eligible intensive care unit patients with Sequential Organ Failure Assessment (SOFA) score of 2 or more. Results: A total of 228 patients were acquired from January 2018 to December 2020, with male predominant (58.8%), mean age of 53.61 years old. The overall 28-day mortality was 57.5%. In the group with PCT ≥ 7 ng/mL, 28-day mortality was 68.5% (87 patients out of a total of 127). Cox regression showed that in this group, the risk of mortality occurring within 28 days from the day of ICU admission was 1.55 times higher (95% CI 1.074-2252, p value 0.02). Independent sample t-test showed that in this group, the mean SOFA score was higher by 2.279 (95% CI 1.497-3.060, p value <0.001). Conclusion: Procalcitonin levels are associated with mortality and SOFA scores in sepsis patients. Further studies need to be carried out to provide more evidence so that it can help reduce the mortality and morbidity of sepsis.

A Retrospective Analysis of the Bacterial Infections, Antibiotic Use, and Mortality Predictors of COVID-19 Patients.

Purpose: This study aimed to investigate the rate and profile of bacterial infections, mortality-associated predictors, and report the most common microorganisms and antibiotic use in coronavirus disease-19 (COVID-19) patients. Patients and Methods: This study used a retrospective approach to evaluate the bacterial culture, antibiotic use, comorbidities, imaging, and laboratory discoveries of patients with COVID-19 (hospitalized) confirmed by reverse transcription polymerase chain reaction (RT-PCR) between May and December 2020. We have selected 906 COVID-19 positive patients using a consecutive sampling technique and analyzed data using IBM SPSS-22 statistical software. Statistical analysis included univariate, bivariate, and multivariate analysis. It was carried out using multivariable logistic regression analysis to predict the mortality of COVID-19 patients. Results: A total of 410 patients, which involved 247 males with a mean age of 53.9 years were evaluated. Based on the results, the positive bacterial culture was detected in 18.3% of all patients who sent the culture sample test, representing bacterial infections. The Acinetobacter baumannii was the most commonly identified organism, while the proportion of patients treated with antibiotics was 83.4%. Furthermore, azithromycin was prescribed in the highest number of patients with approximately 44.3% of all antibiotics. The total mortality rate was 39.8% and its ratio was higher in COVID-19 patients with bacterial infections (65.3%, X2 = 25.1, P<0.001). Patients mortality who used antibiotics were also higher compared to those who did not (89% vs 11%, P<0.014). Age, length of hospitalization, bacterial infection, shortness of breath, neutrophil-to-lymphocyte ratio (NLR), and diabetes mellitus were also associated predictors to increased hospital mortality (adjusted OR (aOR) 0.382, P<0.013; aOR 4.265, P<0.001; aOR 3.720, P<0.001; aOR 3.889, P<0.001; aOR 6.839, P<0.003; aOR 1.844, P<0.030), respectively. Conclusion: This study discovered that there is high use of antibiotics amongst COVID-19 patients; however, the bacterial infection rates did not exceed one-fifth of the total patients. Furthermore, older age, bacterial infections, a longer length of hospitalization, diabetes mellitus, shortness of breath, and higher NLR have a significant impact on the mortality of COVID-19 patients.

Evaluation of Empirical Meropenem Bolus Protocol in Pseudomonas aeruginosa: A Three-Year Analysis in Tertiary Intensive Care Unit.

PURPOSE: To describe meropenem empirical use, susceptibility trend, and associated factors for acquired nonsusceptibility in P. aeruginosa in the intensive care unit. PATIENTS AND METHODS: This study was conducted in the intensive and high care unit of a tertiary care hospital in Indonesia to evaluate empirical meropenem bolus administration protocol. All patients admitted during the 3 year study period from January 2018 through January 2021 with culture-confirmed P. aeruginosa infection were included in the study. Primary data were collected from hospital database electronic medical record and series of local biannual report of microorganism susceptibility pattern. RESULTS: The data suggested that there was increasing trend in meropenem nonsusceptibility and multidrug-resistance rates. A total of 135 patients with various primary diagnoses and comorbidities were studied. P. aeruginosa isolates were mostly (73.4%) obtained from sputum specimen. Empirical meropenem therapy was administrated in 24.4% of patients with standard- and high-dose as indicated. Nonsusceptibility was acquired in 37% patients who mostly received empirical therapy. Multivariable analysis revealed protocol being evaluated as a statistically significant risk factor for nonsusceptibility in P. aeruginosa (PR = 30.65; p <0.001). CONCLUSION: Empirical meropenem administration protocol in this study was an independent determinant of nonsusceptibility acquisition in P. aeruginosa. These findings proved that empirical therapeutic strategy modification is indispensable and routine evaluation practice should be promulgated.