Acinetobacter baumannii infection in a medical intensive care unit: The impact of strict infection control

Abstract

Background. Acinetobacter baumannii is a waterborne organism that preferentially colonises aquatic environments. Infections usually involve organ systems that have a high fluid content. Multidrug-resistant (MDR) A. baumannii is recognised to be among the most difficult antimicrobial-resistant Gram-negative bacilli to prevent and treat in the nosocomial setting. Objective. To determine the utility of concomitant implementation of a strict antimicrobial stewardship programme and comprehensive infection control measures to control MDR A. baumannii in a medical intensive care unit (ICU). Methods. We retrospectively compared the relative incidence of A. baumannii infections in our unit over a 1-year period before (2012) and after (2016) the implementation of strict infection control bundles. Patients with A. baumannii infections were identified using the microbiology database of the National Health Laboratory Service's central data warehouse. The total number of admissions and clinical data were derived from the ICU registry. Results. A. baumannii was isolated from 43/263 patients (16.35%) in 2012 compared with 37/348 patients in 2016 (10.63%, p=0.03; relative risk reduction=35%). We found almost 100% sensitivity to colistin and tigecycline, but 90% resistance to carbapenem antibiotics. Conclusion. The introduction of strict infection control bundles had a statistically significant and clinically meaningful impact on the incidence of nosocomial A. baumannii infection in the medical ICU.

Predictive validity of the quick Sequential Organ Failure Assessment (qSOFA) score for the mortality in patients with sepsis in Vietnamese intensive care units

“…infection control bundles [42] and associated with an increased risk of death [43,44]. All these findings indicated that the patients, pathogens, and clinical capacity to manage sepsis differ considerably among regions, especially between HIC and LMIC settings, and might explain that our proportions for the ICU and hospital mortality were higher than the rates reported in EPIC III study [37].…”

Sequential Organ Failure Assessment (SOFA) score for predicting mortality in patients with sepsis in Vietnamese intensive care units: A multicentre, cross-sectional study

“…(4, 35, 46-48) Furthermore, Acinetobacter baumannii (17.9%, 45/252; Table S4 as shown in Supplementary file 3), one of the most harmful pathogens, was more frequently isolated from patients in the present study than those from the HIC cohort (4.4%; 137/3113) of the EPIC III study (45). The previous studies showed that Acinetobacter baumannii infection was often due to a lack of strict infection control bundles(49) and associated with an increased risk of death(50, 51). The fact that our proportions for ICU and hospital mortality were higher than those reported in the EPIC III study suggested that patients, pathogens, and clinical capacity to manage sepsis vary significantly between regions, particularly between HIC and LMIC settings.…”

Treatment outcomes of Acinetobacter baumannii-associated pneumonia and/or bacteraemia at the intensive care unit of Universitas Academic Hospital, Bloemfontein, South Africa

“…The patients included in our study were relatively young, since limited ICU resources often require prioritising better prognostic candidates and triaging of patients at the time of admission. Mortality rates of 18.9% [13] and 26.5 per 100 person years [12] were reported from Tygerberg and Groote Schuur hospitals, the largest tertiary hospitals in Cape Town, respectively. This is similar to the mortality rate of 22.2% of patients treated with a combination of colistin and tigecycline in our study, but markedly lower than the 71.4% mortality we found in the colistin monotherapy group.…”