Extensively drug-resistant Acinetobacter baumannii complex (ABC) colonization and clinical outcomes in neonates in a tertiary hospital, South Africa: 2020–2022

Abstract

Abstract Background: Extensively drug-resistant Acinetobacter baumannii (XDR-AB) is a significant cause of healthcare-associated infections, particularly in neonatal intensive care units. This study aimed to determine the prevalence of XDR-AB colonization and the odds of subsequent invasive infection. The secondary objectives were to identify risk factors and in-hospital outcomes. Methods: A retrospective study was conducted among 485 neonates admitted to Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa, from June 1, 2020 to December 31, 2022, using laboratory data and medical records. Results: Among 485 neonates, 116 babies (23.9%) were colonized with XDR-AB, with a median colonization age of 4 days. A total of 32 neonates developed invasive infections. Invasive XDR-AB disease was significantly more common among colonized neonates (29 neonates (25%)) compared to 3 (0.81%) non-colonized neonates. In-hospital mortality was significantly higher in colonized neonates (12 (10.34%)) compared to non-colonized neonates (5 cases (1.36%)). Other in-hospital outcomes were not significantly associated with colonization status. Independent colonization risk factors were all affected by confounding. Conclusions: This study highlights the high prevalence of early colonization and subsequent invasive disease with its associated mortality in neonates. Screening of neonates for early colonization helps in empiric antibiotic choices for those found to be colonized.