From the *Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla; and †Division of Infectious Diseases, Department of Medicine, Thammasat University Hospital, Pratumthani, Thailand.
Pediatr Infect Dis J. 2013 Feb;32(2):140-5. doi: 10.1097/INF.0b013e318270b108.
Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a serious threat among critically ill neonates.
We performed a case-case-control study in a Thai neonatal intensive care unit to identify risk factors and outcomes for CRAB bacteremia. Case group (CG) I was defined as cases with CRAB (n = 14), and CG II was defined as cases with carbapenem-susceptible A. baumannii (n = 38) bacteremia. The control group (n = 44) was selected from all patients admitted before and after 3 days that CG I was identified, but had no infection.
The mean gestational age and birth weight of CG I, II and control were 33.5, 35.2 and 35.2 weeks and 1856.5, 2273.9 and 2309.5 g, respectively. By multivariate analysis, CG I was more likely to have had an umbilical artery catheter (adjusted odds ratio = 29.30; P = 0.019) whereas CG II was more likely exposed to ceftazidime (adjusted odds ratio = 5.19; P = 0.046) and aminoglycosides (adjusted odds ratio = 35.59; P = 0.002). There was a significant difference in history of cefoperazone/sulbactam (21.4% versus 0%; P = 0.01) and imipenem use (35.7% versus 0%; P < 0.001) among CG I compared with control. Crude mortality in CG I was higher than CG II (42.9% versus 13.2%; odds ratio = 5.0; P = 0.02).
Our cohort of neonatal CRAB bacteremia is characterized by a very high mortality. Infection-control interventions inclusive of strict adherence to infection-control process for central vascular line placement and maintenance as well as antimicrobial stewardship program are essential to help reduce CRAB bacteremia.
耐碳青霉烯鲍曼不动杆菌（CRAB）已成为危重新生儿的严重威胁。
我们在泰国新生儿重症监护病房进行了病例对照研究，以确定 CRAB 菌血症的危险因素和结局。病例组（CG）I 定义为 CRAB 感染病例（n=14），CG II 定义为碳青霉烯敏感鲍曼不动杆菌感染病例（n=38）。对照组（n=44）选自 CG I 确定前 3 天和后 3 天所有入院患者，但无感染。
CG I、CG II 和对照组的平均胎龄和出生体重分别为 33.5、35.2 和 35.2 周和 1856.5、2273.9 和 2309.5g。多变量分析显示，CG I 更有可能使用脐动脉导管（调整后的优势比=29.30；P=0.019），而 CG II 更有可能接触头孢他啶（调整后的优势比=5.19；P=0.046）和氨基糖苷类（调整后的优势比=35.59；P=0.002）。CG I 与对照组相比，头孢哌酮/舒巴坦（21.4%对 0%；P=0.01）和亚胺培南使用史（35.7%对 0%；P<0.001）有显著差异。CG I 的粗死亡率高于 CG II（42.9%对 13.2%；优势比=5.0；P=0.02）。
我们的新生儿 CRAB 菌血症队列的特点是死亡率非常高。感染控制干预措施，包括严格遵守中央血管通路放置和维护的感染控制流程以及抗菌药物管理计划，对于帮助减少 CRAB 菌血症至关重要。
