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ICU-associated Acinetobacter baumannii colonisation/infection in a high HIV-prevalence resource-poor setting
Ntobeko B A Ntusi1, Motasim Badri, Hoosain Khalfey
1The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
Plos One
|January 10, 2013
Summary
Acinetobacter baumannii colonization and infection are common in African ICUs, leading to high mortality. HIV-infected patients with advanced immunosuppression face increased death risk from this ICU-associated pathogen.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Public Health in Resource-Poor Settings
Background:
- Limited data exist on Acinetobacter baumannii (A. baumannii) colonization/infection incidence, risk factors, and outcomes in HIV-infected and uninfected individuals in African ICUs.
- Resource-poor settings present unique challenges for managing ICU-associated infections.
Purpose of the Study:
- To determine the incidence, risk factors, and outcomes of A. baumannii colonization/infection in critically ill patients in a South African ICU.
- To investigate the impact of HIV co-infection on mortality and A. baumannii-related outcomes.
Main Methods:
- A retrospective review of case records of patients admitted to adult respiratory and surgical ICUs in Cape Town, South Africa, between January 1 and December 31, 2008.
- A. baumannii colonization/infection was defined based on microbiological isolation and clinical presentation.
- Statistical analysis identified independent predictors of mortality.
Main Results:
- The incidence of A. baumannii colonization/infection was 15 per 100 person-years, with an in-ICU mortality rate of 26.5 per 100 person-years.
- Independent predictors of mortality included older age, low CD4 count in HIV-infected patients, surgical intervention, Gram-negative sepsis, high APACHE-II score, multi-organ dysfunction syndrome, and positive blood culture for A. baumannii.
- HIV-positive patients with advanced immunosuppression (CD4<200 cells/mm³) had significantly higher in-ICU mortality.
Conclusions:
- A. baumannii infection is prevalent and associated with high mortality in critically ill patients in this resource-poor African setting.
- Advanced immunosuppression in HIV co-infected patients significantly increases the risk of death due to A. baumannii.
- Findings highlight the urgent need for improved infection control and management strategies for A. baumannii in similar settings.
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