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

Int J Infect Dis. 2009 Sep;13(5):623-8. doi: 10.1016/j.ijid.2008.08.029. Epub 2009 Jan 13.


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 male 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 multidrug-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.

MeSH terms

  • Acinetobacter Infections / epidemiology
  • Acinetobacter Infections / microbiology
  • Acinetobacter Infections / mortality
  • Acinetobacter baumannii / drug effects*
  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia* / epidemiology
  • Bacteremia* / microbiology
  • Bacteremia* / mortality
  • Case-Control Studies
  • Cross Infection* / epidemiology
  • Cross Infection* / microbiology
  • Cross Infection* / mortality
  • Drug Resistance, Multiple, Bacterial*
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Very Low Birth Weight
  • Intensive Care Units, Neonatal / statistics & numerical data*
  • Length of Stay
  • Male
  • Middle East / epidemiology
  • Prevalence
  • Respiration, Artificial
  • Risk Factors


  • Anti-Bacterial Agents