Increasing of Carbapenem-Resistant and Multiple drug-Resistant Acinetobacter baumannii in Maharat Nakhon Ratchasima Hospital
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Abstract
Mutiple drug-resistant gram negative bacilli (MDRGNB) infection leads to limited choice of antibiotic drug usage. Trend of resistance to carbapenem which was previously the broadest and most effective antibiotic has also been noted. Objective: To study MDRGNB and carbapenam resistant in Maharat Nakhon Ratchasima Hospital. Materials & Methods: Retrospective review of bacteriological culture result from clinical microbiology division, Department of Clinical Pathology, Maharat Nakhon Ratchasima Hospital during 2003 to 2007. Results: Among 298,400 cultures, Acinetobacter baumannii (A. baumannii) is the most common multiple-drug resistance (MDRGNB) (56%, 58%, 59%, 55% and 70% of all MDRGNB during 2003 to 2007). In addition A. baumannii ranks highest in etiologic agents of nosocomial respiratory infection. The percentage of multiple drug-resistance of A. baumannii (MDRAB) has been increasing over 5-year duration (40%, 42%, 45%, 67% and 70%). The rate of carbapenem resistance among MDRAB has also increased while the resistance pattern of non-MDR strain remains stable (70%, 71% in 2003 to 72%, 73% in 2007). Further study shows that MDRABs in pediatric and surgical intensive care units (ICU) are more prevalent and none in 2007 are sensitive to carbapenam. During the same period of time, carbapenem group expenditure rises up every year, showing trend of high usage and possible selective pressure. The study also reveals emergence of pandrug-resistant A. baumannii beginning from 6% in 2003 to 23% in 2007. Other groups of antibiotics (e.g. gentamicin, netilmicin, piperacillin/tazobactam, ciprofloxacin and cefipime) commonly used for therapy of gram-negative bacterial infection are also less active except cefoperazone/sulbactam which has lowest percentage of resistance (47%). Conclusion: A. baumannii is the most common MDRGNB and the most common cause of nosocomial respiratory tract infection. Incidence of carbapenem-resistance is higher in pediatric ICU and surgical ICU and pandrug-resistance has emerged.
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