Nursing and Management of Patients Infected with Multidrug-Resistant Acinetobacter baumannii Using Mechanical Ventilation: A Comparative Case Study of 2 Patients

Abstract

Infections caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) are frequently observed in critically ill patients, particularly in intensive care units (ICUs), especially among those requiring prolonged mechanical ventilation. This pathogen exhibits resistance to multiple antibiotic classes, including carbapenems, aminoglycosides, and fluoroquinolones. Clinical manifestations include high fever, respiratory distress, decreased oxygen saturation, and purulent sputum. These infections can lead to severe complications such as ventilator-associated pneumonia (VAP), bloodstream infections, acute kidney injury, or even death. This study aimed to compare the nursing care and clinical management of two patients with MDR-AB infections who were admitted to the ICU and placed on mechanical ventilation at Kantharalak Hospital. Data collection tools included medical record review forms, caregiver interviews, and direct observations. The analysis focused on comparing risk factors, complications, pathophysiology, symptoms, treatments, nursing diagnoses, discharge planning, and the content of care provided.

Case 1 involved a 28-year-old male with a history of alcohol consumption and smoking, diagnosed with sepsis and scrub typhus, and co-infected with MDR Acinetobacter baumannii and Stenotrophomonas maltophilia. He was placed on mechanical ventilation from day one of admission. Treatment included targeted antibiotics such as colistin and levofloxacin, which led to improvement, and the patient was safely discharged. Case 2 was a 12-year-old male diagnosed with septic arthritis of the right knee and sepsis. MDR-AB was detected, and he was treated in the ICU with joint aspiration and three days of mechanical ventilation. Ceftriaxone and adjusted antibiotics based on MIC results were administered, resulting in good clinical outcomes and control of complications.

The study found that MDR-AB infections in ventilated patients vary based on patient context and underlying factors. The first case involved personal behavior and comorbidities, while the second case involved infection from an external wound in an otherwise healthy patient. Strict adherence to infection control protocols, vigilant monitoring, and interprofessional communication played critical roles in improving clinical outcomes.