Risk Factors and Predictors of Mortality in Critically ill Children with Extensively-Drug Resistant Acinetobacter baumannii Infection in a Pediatric Intensive Care Unit

Objective: Acinetobacter baumannii is an important emerging cause for extensively-drug resistant (XDR) hospital associated infections (HAIs) in pediatric intensive care units (PICU). The study was done to evaluate the risk factors, outcome, antibiotic sensitivity pattern, and predictors of mortality in critically ill children with XDR A. baumannii infection. Methods: Retrospective case control study, done in the PICU of a tertiary care pediatric hospital of India from April 2010 to March 2012. Findings: Eighty-five children who developed XDR A. baumannii infection matched to 170 controls. Majority (76%) of the organisms were isolated from endotracheal lavage. The mortality rate was 28.2% (24/85). The factors found to be significantly associated with A. baumannii infection were prior use of broad-spectrum antibiotics, major surgeries done, prolonged PICU stay, use of central venous catheters, and mechanical ventilation. The predictors of mortality associated with A. baumannii infection were acute kidney injury, presence of septic shock, and disseminated intravascular coagulopathy. Colistin found to be the single most effective drug against XDR A. baumannii infection. Conclusion: XDR A. baumannii infections are associated with high morbidity and mortality in critically ill children. Early diagnosis and treatment are crucial. Implementation of infection control practices and rational use of antibiotics are required to control such infections.