independent risk factor for infection with resistant Acinetobacter

Q: Bedridden status is itself an independent risk factor for infection with resistant Acinetobacter? 

A) True 

B) False 

 Answer: A 

 The objective of this question is to highlight the various factors which are modifiable to decrease the risk of healthcare-acquired infections. Acinetobacter infection is one hard-to-treat infection in ICUs as resistance to primary antibiotics is high and second-line antibiotics have either high side-effects or require prolonged treatment. The requirement for isolation can also become challenging and costly. Few of the risk-factors are influenced by the practice of healthcare like overuse of carbapenems or fluoroquinolone, not practicing early mobilization, prolong or overuse of central lines (including PICC), prolonged mechanical ventilation, and overuse of glucocorticoids. 

Another less known fact is that prior colonization with methicillin-resistant S. aureus (MRSA) is an independent risk factor for infection with resistant strains of Acinetobacter - a result of overuse of antibiotics, poor isolation, and hand-hygiene. 

Some of the risk factors are hard to modify such as recent surgery, hemodialysis, or malignancy.

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References:

1. Tacconelli E, Cataldo MA, De Pascale G, et al. Prediction models to identify hospitalized patients at risk of being colonized or infected with multidrug-resistant Acinetobacter baumannii calcoaceticus complex. J Antimicrob Chemother 2008; 62:1130. 

2.  Vitkauskiene A, Dambrauskiene A, Cerniauskiene K, et al. Risk factors and outcomes in patients with carbapenem-resistant Acinetobacter infection. Scand J Infect Dis 2013; 45:213.

3. Karruli A, Boccia F, Gagliardi M, et al. Multidrug-Resistant Infections and Outcome of Critically Ill Patients with Coronavirus Disease 2019: A Single Center Experience. Microb Drug Resist 2021.