Al-Sheikh, YA

Gopalkrishnan, S

Gowda, KL

John, J

Marie, MAM

English

AJOL - African Journals Online

LETTER TO THE EDITORA 6-year surveillance of antimicrobial resistance patternsof Acinetobacter baumannii bacteremia isolates from atertiary care hospital in Saudi Arabia during 20052010Multidrug resistance (MDR) of Acinetobacterbaumannii increasingly jeopardizes the healthcare setting leading to substantial mortalityand morbidity globally. During the past decade, entirelyresistant A. baumannii strains presented a real challengeto clinicians and posed difficulties in therapy (1, 2). MDRof A. baumanniiassociated infections, with adverse cli-nical outcomes involving the respiratory tract, blood, softtissues, urinary tract, and central nervous system, sig-nificantly increases the outlay of the infirmary. BeingGram-negative coccobacilli and an obligate aerobe, A.baumannii causes both community- and hospital-acquiredinfection outbreaks in intensive care units especially incountries with tropical climates (3, 4). Of particularconcern, we sought to reveal the status of antimicrobialresistance in A. baumannii bacteremia isolates, the trendsand relative frequency of multidrug resistance pattern andalso the underlying clinical condition among patientswith A. baumannii bacteremia at Riyadh Military hospi-tal, Saudi Arabia, from January 2005 to December 2010.Our retrospective study was conducted at Riyadhmilitary Hospital, Riyadh, Saudi Arabia, which is atertiary health care center with a capacity of 1,200 beds.Identification of the microorganism was done usingthe microbiology laboratory protocol, and those non-repetitive clinical cultures that showed positive for A.baumannii during a 5-year period from January 2005 toDecember 2010 were included in the study. Blood cul-tures were performed using the BACTEC 9,240 system(BectonDickinson Sparks, MD, USA). A total of380 A. baumannii blood isolates were identified in bloodcultures between January 2005 and December 2010and confirmed by API 20 NE (bioMerieux Inc., France).Isolation and identification was followed by anti-biotic typing of these 380 blood isolates by MicroScanWalkAway (Dade Behring Inc., West Sacramento, CA,USA) according to manufacturer specifications. Antibio-tic patterns were determined in accordance with CLSIguidelines. The antimicrobial agents used in this studywere amikacin (AK), ampicillinsulbactam (AMS),cetazidime (CFZ), ceftriaxone (CFN), ciprofloxacin(CIP), gentamicin (GEN), meropenem (MERO), netilmi-cin (NET), piperacillin/tazobactam (PT), trimethoprim/sulfamethoxazole (TM-SXT), and tetracycline (TET).Intermediately, susceptible strains were considered tobe resistant. All laboratory testing was performedaccording to manufacturer specifications for that in-strument in accordance with practices recommended byCLSI.Multidrug resistant A. baumannii (MDR-AB) is classi-cally recognized and defined if it is resistant to three ormore classes of antibiotics. Statistical analysis was doneusing a t-test, and PB0.05 was considered significant.Table 1 depicts the resistance profiles of all the casesand consequently the fluctuations in the susceptibilitypatterns during the study years. Table 2 describes thefrequency of A. baumannii isolation from blood dur-ing the year 20052010 and also the preponderance ofMDR-AB during these retrospective years. Resistance tomost potent drugs for A. baumanniiassociated infec-tions, namely AK, CFN, and MERO firmly increased to50, 71, and 55% during the year 2009 from 21, 42, and12%, respectively during year the 2005. Resistance toAM-S fluctuated in these years maximizing in the year2009 to 60%, and similarly the resistance rates to CIP(60%) and GEN (55%) attained peak values during theyear 2009. It was noted that there has been a steadyincrease in the resistance rates of A. baumannii isolates,thereby increasing the relative frequency of MDR-ABstrains. The number of A. baumannii isolated from bloodculture increased considerably from 49 to 110 in theperiod 20052010. Moreover, MDR-AB-associated in-fections endangered the hospital settings by their sig-nificant predominance in ICU as 76 and 75% in 2006 and2008, respectively. A substantial increase in MDR-ABstrains is horrendous since MDR-AB were significantlyisolated from ICU patients (5). Apart from being MDR,the steady increase in resistance rates of these bacteriemicisolates to MERO is certainly noteworthy as it reflectsthe probability of a nosocomial outbreak of carbapenam-resistant clones of A. baumannii. The number of cases ofMDR-AB isolated from non-ICU patients in the years2005 and 2009 were 12 [63%] and 9 [75%], respectively,which was higher than that isolated from ICU patientsin the same years (7 [37%]) and 3 [25%], respectively).Moreover, the MDR rate was 63% in 2005 whereas 72%in 2009, thus prevailing antimicrobial resistance patternLibyan Journal of MedicineLibyan Journal of Medicine 2014. # 2014 Krishnappa L. Gowda et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium,provided the original work is properly cited.1Citation: Libyan J Med 2014, 9: 24039 - http://dx.doi.org/10.3402/ljm.v9.24039(page number not for citation purpose)among the ICU patients is alarming in the hospitalcare settings.Our retrospective study suggests that there was asubstantial increase in antimicrobial resistance and a rel-ative increase in frequency of the MDR predominatingin the blood culture isolates of A. baumannii. An optimaltreatment for A. baumannii infections has not beenestablished, especially for MDR-AB. Decisions on treat-ment should be made on a case-by-case basis by ahealth care provider. Extensively resistant A. baumanniistrains remain generally susceptible to polymyxins (colis-tin and polymyxin B). Therefore, valid infection con-trol practices and judicious antibiotic strategies arenecessary to contain the outbreaks of MDR-AB innosocomial settings, and clinical alternatives for therapyis mandatory for improved management of infectionsdue to MDR-AB.AcknowledgementsThe authors extend their appreciation to the Research Center at theCollege of Applied Medical Sciences and the Deanship of ScientificResearch at King Saud University for funding this work.Conflict of interest and fundingThe authors certify that there is no conflict of interestwith any financial organization regarding the materialdiscussed in the manuscript.Krishnappa Lakshmana Gowda*Department of Clinical Laboratory SciencesCollege of Applied Medical SciencesKing Saud UniversityRiyadh, Kingdom of Saudi ArabiaMohammed A. M. Marie*Department of Clinical Laboratory SciencesCollege of Applied Medical SciencesKing Saud UniversityRiyadh, Kingdom of Saudi ArabiaEmail: dr.mmarieali@gmail.comYazeed A Al-SheikhDepartment of Clinical Laboratory SciencesCollege of Applied Medical SciencesKing Saud UniversityRiyadh, Kingdom of Saudi ArabiaJames JohnDepartment of Clinical MicrobiologyChristian Medical College and HospitalVellore, IndiaSangeetha GopalkrishnanDepartment of MicrobiologyCentral Leprosy Training and Research InstituteChennai, IndiaTable 1. Prevalence and resistance trends of Acinetobacter baumannii bacteremia isolates at Riyadh military hospital, 20052010Resistance prevalence (%)Year Isolates AK AM-S CFZ CFN CIP GEN MERO NET AUG TM-SXT2005 49 29 35 41 51 29 31 12 15 39 292006 48 35 30 48 52 35 44 35 22 62 372007 85 37 22 46 57 42 44 35 21 51 422008 106 50 51 53 59 49 53 47 36 61 462009 99 50 60 58 71 60 55 55 42 78 472010 110 44 42 54 60 47 42 51 32 70 44Table 2. Characteristic of patients infected with MDR Acinetobacter baumannii bacteremiaCharacteristic 2005 2006 2007 2008 2009 2010Mean age (years) 37 44 49 51 52 50Male 28 28 44 62 46 58Female 21 20 42 46 53 52ICU patients 16 24 25 37 41 23Non-ICU patients 33 24 61 71 58 87No. of isolated MDR 11 13 29 48 53 52MDR in ICU (%) 7 (63) 10 (76) 19 (66) 36 (75) 38 (72) 18 (35)+Contributed equally.Krishnappa L. Gowda et al.2(page number not for citation purpose)Citation: Libyan J Med 2014, 9: 24039 - http://dx.doi.org/10.3402/ljm.v9.24039Pradeep Chikkabidare ShashidharDepartment of Clinical Laboratory SciencesCollege of Applied Medical SciencesKing Saud UniversityRiyadh, Kingdom of Saudi ArabiaKhaled Homoud M. DabwanDepartment of Clinical Laboratory SciencesCollege of Applied Medical SciencesKing Saud UniversityRiyadh, Kingdom of Saudi ArabiaReferences1. Koeleman JG, Parlevliet GA, Dijkshoorn L, Savelkoul PH,Vandenbroucke-Grauls CM. Nosocomial outbreak of multi-resistant Acinetobacter baumannii on a surgical ward: epidemiol-ogy and risk factors for acquisition. J Hosp Infect. 1997; 37:11323.2. Sengstock DM, Thyagarajan R, Apalara J, Mira A, ChopraT, Kaye KS. Multidrug-resistant Acinetobacter baumannii: anemerging pathogen among older adults in community hospitalsand nursing homes. Clin Infect Dis. 2010; 50: 161116.3. Montefour K, Frieden J, Hurst S, Helmich C, Headley D,Martin M, et al. Acinetobacter baumannii: an emerging multidrug-resistant pathogen in critical care. Crit Care Nurse. 2008; 28:1525.4. Richet H, Fournier PE. Nosocomial infections caused byAcinetobacter baumannii: a major threat worldwide. Infect Con-trol Hosp Epidemiol. 2006; 27: 6456.5. Fournier PE, Richet H. The epidemiology and control ofAcinetobacter baumannii in health care facilities. Clin InfectDis. 2006; 42: 6929.Letter to the editorCitation: Libyan J Med 2014, 9: 24039 - http://dx.doi.org/10.3402/ljm.v9.24039 3(page number not for citation purpose)

Letter to the Editor: A 6-year surveillance of antimicrobial resistance patterns of Acinetobacter baumannii bacteremia isolates from a tertiary care hospital in Saudi Arabia during 2005-2010

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Letter to the Editor: A 6-year surveillance of antimicrobial resistance patterns of Acinetobacter baumannii bacteremia isolates from a tertiary care hospital in Saudi Arabia during 2005-2010

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