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Volume 5, Issue 8

Risk factors for acquiring infection in the intensive care unit: experience from a Moroccan hospital Open Access

Abstract

species are non-fermenting and ubiquitous Gram-negative coccobacilli, which in recent years have become the leading cause of healthcare-associated infections worldwide. Our objective here was to study the epidemiology and risk factors associated with infections in the intensive care unit (ICU).

This retrospective case-control study was conducted collaboratively between the Medical Bacteriology Department and the two ICUs of the Military Hospital of Instruction Mohammed V-Rabat over a 3 month period.

We included 180 patients, of whom 60 had infection. We observed a male predominance in both matched groups, with a sex ratio of 1.6. The median age was 67 years [interquartile range (IQR) 59.5–77]. The median length of stay in the ICU before infection was 8.5 days (IQR 5–14). Multivariate logistic regression analysis identified the risk factors statistically associated with infection at the ICU level as follows: duration of invasive procedures >7 days [odds ratio (OR)=1.02], parenteral nutrition (OR=3.514), mechanical ventilation (OR=3.024), imipenem (OR=18.72), colistin (OR=5.645), probabilistic antibiotic therapy >4 days (OR=9.063) and neoplastic pathology (OR=5.727).

Based on our results, it can be inferred that shortening the duration of stay in the resuscitation setting, implementing rational use of medical devices and optimizing antibiotic therapy could decrease the incidence of these infections.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): Acinetobacter baumannii , infection , intensive care units and risk factors
© 2023 The Authors
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.
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2023-09-22
2025-04-21
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References

  1. Uwingabiye J, Frikh M, Lemnouer A, Bssaibis F, Belefquih B et al. Acinetobacter infections prevalence and frequency of the antibiotics resistance: comparative study of intensive care units versus other hospital units. Pan Afr Med J 2016; 23:191 [View Article] [PubMed]
     [Google Scholar]
  2. Uwingabiye J, Lemnouer A, Roca I, Alouane T, Frikh M et al. Clonal diversity and detection of carbapenem resistance encoding genes among multidrug-resistant Acinetobacter baumannii isolates recovered from patients and environment in two intensive care units in a Moroccan hospital. Antimicrob Resist Infect Control 2017; 6:99 [View Article] [PubMed]
     [Google Scholar]
  3. Lanjri S, Uwingabiye J, Frikh M, Abdellatifi L, Kasouati J et al. In vitro evaluation of the susceptibility of Acinetobacter baumannii isolates to antiseptics and disinfectants: comparison between clinical and environmental isolates. Antimicrob Resist Infect Control 2017; 6:36 [View Article] [PubMed]
     [Google Scholar]
  4. Lin MF, Lan CY. Antimicrobial resistance in Acinetobacter baumannii: from bench to bedside. World J Clin Cases 2014; 2:787–814 [View Article] [PubMed]
     [Google Scholar]
  5. Elouennass M, Bajou T, Lemnouer AH, Foissaud V, Hervé V et al. Acinetobacter baumannii: étude de la sensibilité des souches isolées à l’hôpital militaire d’instruction Mohammed V, Rabat, Maroc. Med Mal Infect 2003; 33:361–364 [View Article]
     [Google Scholar]
  6. Benaissa E, Abassour T, Belouad E, Maleb A, Elouennass M. Characterization of imipenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa clinical isolates in a Moroccan hospital. Acta Microbiol Immunol Hung 2022 [View Article] [PubMed]
     [Google Scholar]
  7. Punpanich W, Nithitamsakun N, Treeratweeraphong V, Suntarattiwong P. Risk factors for carbapenem non-susceptibility and mortality in Acinetobacter baumannii bacteremia in children. Int J Infect Dis 2012; 16:e811–5 [View Article] [PubMed]
     [Google Scholar]
  8. Özgür ES, Horasan ES, Karaca K, Ersöz G, Naycı Atış S et al. Ventilator-associated pneumonia due to extensive drug-resistant Acinetobacter baumannii: risk factors, clinical features, and outcomes. Am J Infect Control 2014; 42:206–208 [View Article] [PubMed]
     [Google Scholar]
  9. Townsend J, Park AN, Gander R, Orr K, Arocha D et al. Acinetobacter infections and outcomes at an academic medical center: a disease of long-term care. Open Forum Infect Dis 2015; 2:ofv023 [View Article] [PubMed]
     [Google Scholar]
  10. Liu Q, Li W, Du X, Li W, Zhong T et al. Risk and prognostic factors for multidrug-resistant Acinetobacter baumannii complex bacteremia: a retrospective study in a tertiary hospital of West China. PLoS One 2015; 10:e0130701 [View Article] [PubMed]
     [Google Scholar]
  11. Ñamendys-Silva SA, Correa-García P, García-Guillén FJ, González-Herrera MO, Pérez-Alonso A et al. Outcomes of critically ill cancer patients with Acinetobacter baumannii infection. World J Crit Care Med 2015; 4:258–264 [View Article] [PubMed]
     [Google Scholar]
  12. Cisneros JM, Rodríguez-Baño J, Fernández-Cuenca F, Ribera A, Vila J et al. Risk-factors for the acquisition of imipenem-resistant Acinetobacter baumannii in Spain: a nationwide study. Clin Microbiol Infect 2005; 11:874–879 [View Article] [PubMed]
     [Google Scholar]
  13. Chopra T, Marchaim D, Johnson PC, Awali RA, Doshi H et al. Risk factors and outcomes for patients with bloodstream infection due to Acinetobacter baumannii-calcoaceticus complex. Antimicrob Agents Chemother 2014; 58:4630–4635 [View Article] [PubMed]
     [Google Scholar]
  14. Ardoino I, Zangirolami F, Iemmi D, Lanzoni M, Cargnelutti M et al. Risk factors and epidemiology of Acinetobacter baumannii infections in a university hospital in Northern Italy: a case-control study. Am J Infect Control 2016; 44:1600–1605 [View Article] [PubMed]
     [Google Scholar]
  15. Turkoglu M, Mirza E, Tunçcan ÖG, Erdem GU, Dizbay M et al. Acinetobacter baumannii infection in patients with hematologic malignancies in intensive care unit: risk factors and impact on mortality. J Crit Care 2011; 26:460–467 [View Article] [PubMed]
     [Google Scholar]
  16. García-Garmendia JL, Ortiz-Leyba C, Garnacho-Montero J, Jiménez-Jiménez FJ, Pérez-Paredes C et al. Risk factors for Acinetobacter baumannii nosocomial bacteremia in critically ill patients: a cohort study. Clin Infect Dis 2001; 33:939–946 [View Article] [PubMed]
     [Google Scholar]
  17. Manchanda V, Sanchaita S, Singh N. Multidrug resistant Acinetobacter. J Glob Infect Dis 2010; 2:291–304 [View Article] [PubMed]
     [Google Scholar]
  18. Ang H, Sun X. Risk factors for multidrug-resistant Gram-negative bacteria infection in intensive care units: a meta-analysis. Int J Nurs Pract 2018; 24:e12644 [View Article] [PubMed]
     [Google Scholar]
  19. Fang C, Chen X, Zhou M. Epidemiology and cytokine levels among children with nosocomial multidrug-resistant Acinetobacter baumannii complex in a tertiary hospital of Eastern China. PLoS One 2016; 11:e0161690 [View Article] [PubMed]
     [Google Scholar]
  20. Michalopoulos A, Falagas ME, Karatza DC, Alexandropoulou P, Papadakis E et al. Epidemiologic, clinical characteristics, and risk factors for adverse outcome in multiresistant gram-negative primary bacteremia of critically ill patients. Am J Infect Control 2011; 39:396–400 [View Article] [PubMed]
     [Google Scholar]
  21. Ang H, Sun X. Risk factors for multidrug-resistant Gram-negative bacteria infection in intensive care units: a meta-analysis. Int J Nurs Pract 2018; 24:29575345 [View Article] [PubMed]
     [Google Scholar]
  22. Osthoff M, McGuinness SL, Wagen AZ, Eisen DP. Urinary tract infections due to extended-spectrum beta-lactamase-producing Gram-negative bacteria: identification of risk factors and outcome predictors in an Australian tertiary referral hospital. Int J Infect Dis 2015; 34:79–83 [View Article] [PubMed]
     [Google Scholar]
  23. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39:309–317 [View Article] [PubMed]
     [Google Scholar]
  24. Nutman A, Glick R, Temkin E, Hoshen M, Edgar R et al. A case-control study to identify predictors of 14-day mortality following carbapenem-resistant Acinetobacter baumannii bacteraemia. Clin Microbiol Infect 2014; 20:1028–1034 [View Article] [PubMed]
     [Google Scholar]
  25. Gu Z, Han Y, Meng T, Zhao S, Zhao X et al. Risk factors and clinical outcomes for patients with Acinetobacter baumannii bacteremia. Medicine 2016; 95:e2943 [View Article] [PubMed]
     [Google Scholar]
  26. Du B, Long Y, Liu H, Chen D, Liu D et al. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infection: risk factors and clinical outcome. Intensive Care Med 2002; 28:1718–1723 [View Article] [PubMed]
     [Google Scholar]
  27. Lautenbach E, Patel JB, Bilker WB, Edelstein PH, Fishman NO. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001; 32:1162–1171 [View Article] [PubMed]
     [Google Scholar]
  28. Rodríguez-Baño J, Navarro MD, Romero L, Muniain MA, Cueto M de et al. Risk-factors for emerging bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli. Clin Microbiol Infect 2008; 14:180–183 [View Article] [PubMed]
     [Google Scholar]
  29. Baran G, Erbay A, Bodur H, Ongürü P, Akinci E et al. Risk factors for nosocomial imipenem-resistant Acinetobacter baumannii infections. Int J Infect Dis 2008; 12:16–21 [View Article] [PubMed]
     [Google Scholar]
  30. Anunnatsiri S, Tonsawan P. Risk factors and clinical outcomes of multidrug-resistant Acinetobacter baumannii bacteremia at a university hospital in Thailand. Southeast Asian J Trop Med Public Health 2011; 42:693–703 [PubMed]
     [Google Scholar]
  31. Kang C-I, Kim S-H, Park WB, Lee K-D, Kim H-B et al. Bloodstream infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for mortality and treatment outcome, with special emphasis on antimicrobial therapy. Antimicrob Agents Chemother 2004; 48:4574–4581 [View Article] [PubMed]
     [Google Scholar]
  32. Menashe G, Borer A, Yagupsky P, Peled N, Gilad J et al. Clinical significance and impact on mortality of extended-spectrum beta lactamase-producing Enterobacteriaceae isolates in nosocomial bacteremia. Scand J Infect Dis 2001; 33:188–193 [View Article] [PubMed]
     [Google Scholar]
  33. Bellíssimo-Rodrigues F, Gomes ACF, Passos ADC, Achcar JA, Perdoná G da SC et al. Clinical outcome and risk factors related to extended-spectrum beta-lactamase-producing Klebsiella spp. infection among hospitalized patients. Mem Inst Oswaldo Cruz 2006; 101:415–421 [View Article] [PubMed]
     [Google Scholar]
  34. Furtado GHC, Bergamasco MD, Menezes FG, Marques D, Silva A et al. Imipenem-resistant Pseudomonas aeruginosa infection at a medical-surgical intensive care unit: risk factors and mortality. J Crit Care 2009; 24:625 [View Article] [PubMed]
     [Google Scholar]
  35. Kaya O, Akcam FZ, Gonen I, Unal O, Ceylan T. Risk factors for bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli in a Turkish hospital. J Infect Dev Ctries 2013; 7:507–512 [View Article] [PubMed]
     [Google Scholar]
  36. Zavascki AP, Barth AL, Goldani LZ. Nosocomial bloodstream infections due to metallo-beta-lactamase-producing Pseudomonas aeruginosa. J Antimicrob Chemother 2008; 61:1183–1185 [View Article] [PubMed]
     [Google Scholar]
  37. del Mar Tomas M, Cartelle M, Pertega S, Beceiro A, Llinares P et al. Hospital outbreak caused by a carbapenem-resistant strain of Acinetobacter baumannii: patient prognosis and risk-factors for colonisation and infection. Clin Microbiol Infect 2005; 11:540–546 [View Article] [PubMed]
     [Google Scholar]
/content/journal/acmi/10.1099/acmi.0.000637.v3
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Risk factors for acquiring Acinetobacter baumannii infection in the intensive care unit: experience from a Moroccan hospital
Access Microbiology 5, 000637.v3 (2023); https://doi.org/10.1099/acmi.0.000637.v3
/content/journal/acmi/10.1099/acmi.0.000637.v3
/content/journal/acmi/10.1099/acmi.0.000637.v3
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