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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Acinetobacter baumannii microbiological and phenotypic characteristics of isolates from Intensive Care Unit of the Department of Internal Medicine at the University Hospital Centre in Zagreb over a four-year period

Abstract

Acinetobacter baumannii is an opportunistic nosocomial pathogen and one of the six most important multidrug-resistant microorganisms in intensive care units (ICU).

The aim of this study was to determine the prevalence of antimicrobial resistant A. baumannii strains in ICU.

We analysed antibiotic susceptibility of A. baumannii isolates collected in University Hospital Centre Zagreb over a four-year period (2011-2014) based on the hospital computer system data (BIS). The data were interpreted according to Clinical and Laboratory Standards Institute criteria.

All strains from 2014 were found to be resistant to meropenem, which is a significant increase when compared to 1.4% in 2011 and 81.8% in 2012. The resistance rate to imipenem increased to 95.8% in 2014 from 91.4% in 2011 and 81.8% in 2012. Colistin resistance, confirmed by E test, was found only in one strain in 2013. The resistance rates of other antimicrobial agents were as follows: ampicillin/sulbactam 8.6% and 73.9%, netilmicin 70.6% and 83.3%, gentamicin 48.6% and 91.7%, amikacin 82.4% and 80.0% and ciprofloxacin 100% and 100% in 2011 and 2014 respectively.

Our data confirmed a multidrug-resistance phenotype in Acinetobacter baumannii strains isolated in ICU at the Clinical Hospital Centre, with a significant increase in resistance rates between 2011 and 2014 against certain antimicrobial agents including ampicilin/sulbactam and carbapenems.

Key words: Acinetobacter baumannii, multidrug resistance, extensively drug resistance, nosocomial pathogen

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Urinary peritonitis caused by gangrenous cystitis

Abstract

We report a case of a young man who developed severe urinary sepsis, on the 21st day of hospitalization (DH), which was treated with ciprofloxacin and gentamicin. On the 30th DH, he developed bloodstream and urinary infections due to Acinetobacter baumannii which had been treated with colistin and rifampicin. On the 55th DH, he developed urinary peritonitis and necrosis of the anterior and posterior bladder wall. Bilateral ureterostomy was performed. The patient was treated with colistin and imipenem. Peritoneal fluid culture yielded Enterobacter cloacae susceptible to imipenem. An enterocystoplasty was performed. The outcome was favourable.

Keywords: peritonitis, Acinetobacter baumannii, colistin, rifampicin

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