Nosocomial multidrug-resistant Acinetobacter baumannii in the neonatal intensive care unit in Gaza City, Palestine

Objectives: We performed a prospective case-control study of bloodstream infections in order to determine the infection rate of Acinetobacter baumannii and to determine the risk factors associated with infection and mortality. Methods: Between February 2004 and January 2005, 579 consecutive blood specimens were collected from the two neonatal intensive care units (NICUs) of Al-Nasser and Al-Shifa hospitals in Gaza City. Results: Forty (6.9%) isolates of A. baumannii were obtained from neonates aged under 28 days. Of the patients, 62.5% were mate and 37.5% were female. Compared to matched, uninfected controls, statistically significant risk factors were weight <1500 g (odds ratio (OR) 3.89, p < 0.001), age <7 days (OR 2.33, p = 0.027), median hospitalization of =20 days (OR 3.1, p = 0.003), mechanical ventilation (OR 3.5, p = 0.001), use of a central venous catheter (CVC; OR 10.5, p < 0.001), and prior antibiotic use (OR 4.85, p = 0.003). The overall mortality was also significantly different (overall mortality 37.5% in cases vs. 12% in uninfected controls; OR 4.4, p = 0.001). Compared to infected controls, statistically significant risk factors were mechanical ventilation (OR 2.68, p = 0.008), use of a CVC (OR 6.68, p < 0.001), and prior antibiotic use (OR 5.68, p = 0.001). The muttidrug-resistant type was significantly associated with death in the neonates (p = 0.023). The isolates of A. baumannii were resistant to commonly used antibiotics, while susceptible to meropenem (92.5%), imipenem (90%), ciprofloxacin (75%), gentamicin (57.5%), and ceftriaxone (50%). Conclusions: The infection rate with multidrug-resistant A. baumannii is considerable and alarming in NICU infants, and is associated with significant mortality. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.