oa Southern African Journal of Epidemiology and Infection - Multidrug-resistant nosocomial infections among private hospital patients in the North West province : original research
This article reports on severe clinical cases of nosocomial infections that were caused by multidrug-resistant (MDR) isolates of Acinetobacter baumannii and Pseudomonas aeruginosa in an intensive care unit (ICU). Globally, patients in ICUs have encountered an increasing emergence and spread of MDR pathogens. A retrospective case study was conducted to investigate the possible causes and occurrence of nosocomial infections linked to reported cases thereof in a private hospital in the North West province between December 2009 and August 2010. This followed an enquiry from a concerned community member about two patient deaths and a patient who was in the hospital's ICU between July and August 2010 with an infection by an unknown "superbug". Of the 24 adult patients who were admitted to the ICU in the study period, 22 presented with isolates of A. baumannii, one with P. aeruginosa, and one with presumed A. baumannii for which there was no laboratory test confirmation. Of those who were infected with A. baumannii, nine of the 22 died (a case fatality rate of 41%). The patient with no laboratory test confirmation also died within seven days, while the patient who was infected with P. aeruginosa was still in hospital at the end of the study period (August 2010). The average length of stay in the hospital was 21.3 days. Six of the 24 patients (25%) stayed longer than 30 days. A patient who was infected with P. aeruginosa stayed even longer. The most common cause of death among the ICU patients, notwithstanding other underlying conditions, was A. baumannii strain, which may have directly or indirectly contributed to the prolonged length of stay in hospital. It is possible that P. aeruginosa is a recent introduction to this ICU.
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