An outbreak of bloodstream infection due to extensively resistant Acinetobacter baumannii among neonates.

ABSTRACT

BACKGROUND: Extensively resistant Acinetobacter baumannii has emerged and spread worldwide as a significant cause of health care-associated infections and outbreaks. It also causes life-threatening infections among neonates, including bacteremia. The aim of this study was to investigate an outbreak of A baumannii bacteremia (ABB) among neonates. MATERIALS AND METHODS: A retrospective, case-control study was conducted from July 2014 to July 2015 in a neonatal intensive care unit (NICU). Risk factors associated with ABB in univariate and multivariate analysis with logistic regression was performed. Molecular typing by pulsed field gel electrophoresis was used to confirm relatedness of bacteremic A baumannii strains. RESULTS: During the 5-year period (2011-2016), 68 patients in our NICU were diagnosed with BSI due to A baumannii. The case-control study included 41 case patients within the outbreak caused by a major epidemic clone and 108 control patients. Risk factors (by univariate analysis) associated with ABB were intubation, 14-day mortality, and use of peritoneal dialysis and an umbilical catheter. Multivariate analysis identified 14-day mortality (odds ratio, 5.75; 95% confidence interval, 2.58-12.79) and umbilical catheter use (odds ratio, 2.44; 95% confidence interval, 1.1-5.4) as independent risk factors for ABB. CONCLUSIONS: This outbreak of bacteremia due to resistant A baumannii affected 41 infants and was associated with 58% mortality. Control of the outbreak was achieved by implementing long-term sustained infection control measures within the unit.