Introduction: Extensively drug-resistant Acinetobacter baumannii (XDR-AB) is a major cause of healthcare-associated infections (HAIs) and outbreaks in neonatal units. Colonisation is believed to precede subsequent invasive disease.
Objectives: To determine the prevalence and risk factors for XDR-AB colonisation in neonates and determine clinical outcomes.
Methods: A retrospective case-control study was conducted for the period 1 June 2020 to 31 December 2022 at Rahima Moosa mother and child hospital (RMMCH). A total of 485 neonates were included in this study. Laboratory data of all XDR-AB screening swabs (rectal and/or skin) was retrospectively extracted from the National Health Laboratory Services (NHLS) database. Clinical information was obtained from an existing hospital database. Data analysis was performed using STATA version 18.0.
Results: Colonisation with XDR-AB occurred in 116 (23.92%) neonates, mostly in early life (median age of 4 days). Mechanical ventilation increased the odds of colonisation by 2.06 (p=0.009, 95% CI: 1.20-3.56). Invasive disease occurred in 29 (25%) colonised neonates compared to 3 (0.81%) non-colonised neonates (OR 41, p-value=0.0000; 95% CI: 12-211). Colonised neonates had significantly higher in-hospital mortality rate compared to non-colonised neonates (10.43% vs 1.36%, respectively, OR 7.72, p=0.000).
Conclusion: Neonates who are mechanically ventilated should be screened for XDR-AB colonisation. When sepsis occurs, possible invasive XDR-AB disease should be considered. Empiric antibiotics should be tailored to cover XDR-AB in known colonised infants in an effort to reduce mortality.