Korean J Intern Med.  2016 Mar;31(2):367-374. 10.3904/kjim.2015.178.

Controlling endemic multidrug-resistant Acinetobacter baumannii in Intensive Care Units using antimicrobial stewardship and infection control

• Cheon S
• Kim MJ
• Yun SJ
• Moon JY
• Kim YS

• KMID: 2373812
• DOI: http://doi.org/10.3904/kjim.2015.178

Abstract

BACKGROUND/AIMS
Nosocomial infections caused by multidrug-resistant (MDR) Acinetobacter baumannii have become public-health problem. However, few studies have evaluated the control of endemic MDR A. baumannii in Intensive Care Units (ICUs). Therefore, we investigated the effectiveness of antimicrobial stewardship and comprehensive intensified infection control measures for controlling endemic MDR A. baumannii in ICUs at a tertiary care center.
METHODS
Carbapenem use was strictly restricted through antimicrobial stewardship. Environmental cleaning and disinfection was performed at least 3 times per day in addition to basic infection control measures. Isolation using plastic curtains and contact precautions were applied to patients who were colonized or infected with MDR A. baumannii. The outcome was measured as the incidence density rate of hospital-onset MDR A. baumannii among patients in the ICUs.
RESULTS
The incidence density rate of hospital-onset MDR A. baumannii decreased from 22.82 cases per 1,000 patient-days to 2.68 cases per 1,000 patient-days after the interventions were implemented (odds ratio, 0.12; 95% confidence interval, 0.03 to 0.4; p < 0.001). The mean monthly use of carbapenems also decreased from 134.99 +/- 82.26 defined daily doses per 1,000 patient-days to 94.85 +/- 50.98 defined daily doses per 1,000 patient-days (p = 0.016).
CONCLUSIONS
Concomitant implementation of strict antimicrobial stewardship and comprehensive infection control measures effectively controlled endemic MDR A. baumannii in our ICUs within 1 year.

Keyword

Acinetobacter baumannii; Antimicrobial stewardship; Infection control

MeSH Terms

Acinetobacter Infections/epidemiology/microbiology/*prevention & control/transmission
Acinetobacter baumannii/*drug effects/pathogenicity
Anti-Bacterial Agents/adverse effects/*therapeutic use
Carbapenems/adverse effects/*therapeutic use
Chi-Square Distribution
Cross Infection/epidemiology/microbiology/*prevention & control/transmission
Disinfection
*Drug Resistance, Multiple, Bacterial
*Endemic Diseases
Hand Disinfection
Humans
Incidence
Infection Control/*methods
Microbial Sensitivity Tests
Odds Ratio
Patient Isolation
Program Evaluation
Republic of Korea/epidemiology
Risk Factors
Tertiary Care Centers
Time Factors
Treatment Outcome
Anti-Bacterial Agents
Carbapenems