Colonization pressure and risk factors for acquisition of imipenem-resistant Acinetobacter baumannii in a medical surgical intensive care unit in Brazil

Fortaleza, Carlos Magno Castelo Branco; Freitas, Felipe; Lauterbach, Gerhard da Paz

doi:10.1016/j.ajic.2012.03.016

Cited by 24 publications

(13 citation statements)

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“…Contrary to previous reports, prior exposure to antimicrobials was not a risk factor for infection in our study but was associated with an increased risk of colonization (Zanetti et al, 2007;Garnacho-Montero et al, 2005). A previous study conducted in Brazil, where MR-AB colonization is endemic, found that use of antimicrobials was a risk factor for acquisition of MR-AB only when colonization pressure (proportion of patients harboring the microorganism) was low (Castelo Branco Fortaleza et al, 2013). Thus, the absence of association between antimicrobials and MDR-AB infection could be explained either by low sensitivity of analysis (due to small number of infection events) or by high colonization pressure during the outbreak.…”

Section: Discussioncontrasting

confidence: 99%

Incidence, risk factors and outcome of multi-drug resistant Acinetobacter baumannii nosocomial infections during an outbreak in a burn unit

Munier

Biard

Legrand

et al. 2019

International Journal of Infectious Diseases

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A B S T R A C TBackground: Multidrug-Resistant Acinetobacter baumannii (MR-AB) can cause outbreaks in burn units. We aimed to study the incidence, risk factors and outcome of MR-AB infections in a burn unit (BU). Methods: A prospective study was conducted from April to November, 2014 during an outbreak in a BU in Paris. Weekly surveillance cultures were performed to determine MR-AB colonization. MR-AB nosocomial infections, discharge or death without MR-AB infection were considered as competing events. To identify risk factors for MR-AB infection, baseline characteristics and time-dependent variables were investigated in univariate analyses using Cox models. Results: Eighty-six patients admissions were analyzed during the study period. Among them, 15 (17%) acquired MR-AB nosocomial infection. Median time to infection was 22 days (interquartile range: 10-26 days). Cumulative incidence of MR-AB infections was 15% at 28 days (95% CI = 8-24). Risk factors for MR-AB infection in univariate analysis were SAPS II (Hazard Ratio (HR):1.08; 95% CI:1.05-1.12; P < 0.0001) and ABSI (Abbreviated Burn Severity Index) scores (HR:1.32; 95% CI:1.12-1.56; P = 0.001), MR-AB colonization (HR:10.2; 95%CI:2.05-50.3; P = 0.004), invasive procedures (ventilation, arterial and/or venous catheter) (P = 0.0001) and 2 skin grafts (HR:10.2; 95% CI:1.76-59.6; P = 0.010). MR-AB infection was associated with an increased risk of death (HR: 7.11; 95%CI: 1.52-33.2; P = 0.013) and longer hospital stay with a median estimated increase of 10 days (IQR: 6; 14). Conclusions: Incidence of MR-AB nosocomial infection was high during this outbreak, and was associated with prolonged hospitalization and increased risk of death. High patient severity scores, prior MR-AB colonization, invasive procedures and repeated skin grafts were associated with an increased risk of nosocomial infection.

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Section: Discussioncontrasting

confidence: 99%

Incidence, risk factors and outcome of multi-drug resistant Acinetobacter baumannii nosocomial infections during an outbreak in a burn unit

Munier

Biard

Legrand

et al. 2019

International Journal of Infectious Diseases

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“…The overuse of antimicrobials and the neglect of standard routines for hand hygiene have led to the emergence and spread of MDR pathogens in hospital settings, and the adoption of effective measures to prevent nosocomial outbreaks is warranted (4) (28) . The antimicrobial susceptibility profiles evaluated during the period considered in our study indicated a fast increase in circulating CRAb strains, especially when compared to data related to carbapenem-resistant Pseudomonas spp.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial resistance profiles and oxacillinase genes in carbapenem-resistant Acinetobacter baumannii isolated from hospitalized patients in Santa Catarina, Brazil

Cortivo¹,

Gutberlet

Ferreira

et al. 2015

Rev. Soc. Bras. Med. Trop.

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Introduction:Carbapenems are the therapy of choice for treating severe infections caused by the Acinetobacter calcoaceticusAcinetobacter baumannii complex. We aimed to assess the prevalence and antimicrobial susceptibility profi les of producers of distinct oxacillinases among nosocomial isolates of the A. calcoaceticus-A. baumannii complex in a 249-bed general hospital located in Joinville, Southern Brazil. Methods: Of the 139 A. baumannii clinical isolates with reduced susceptibility to carbapenems between 2010 and 2013, 118 isolates from varying anatomical sites and hospital sectors were selected for genotypic analysis. Five families of genes encoding oxacillinases, namely bla OXA-23-like , bla OXA-24-like , bla OXA-51-like , bla OXA-58-like , and bla OXA-143-like , were investigated by multiplex polymerase chain reaction (PCR). Results: Most (87.3%) isolates simultaneously carried the bla OXA-23-like and bla OXA-51-like genes, whereas three (2.5%) isolates harbored only bla OXA-51-like ones. The circulation of carbapenemresistant isolates increased during the study period: from none in 2010, to 22 in 2011, 64 in 2012, and 53 in 2013. Conclusions: Isolates carrying the bla OXA-23-like and bla OXA-51-like genes were widely distributed in the hospital investigated. Because of the worsening scenario, the implementation of preventive measures and effective barriers is needed.

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“…In another study, during an outbreak of A. baumannii , being in the same room as a colonized patient was an independent risk factor for colonization (11). In a third study, antimicrobial use was not a risk factor for the acquisition of MRAC if CP exceeded 8.7% (6). A recent systematic review found a consistent relationship between CP and the risk of acquisition of methicillin-resistant Staphylococcus aureus , vancomycin-resistant Enterococcus spp.…”

Section: Discussionmentioning

confidence: 99%

“…However, we were interested in evaluating the data produced during that period to understand the reasons for the failure of the interventions. As an association between CP and gram-negative cross-transmission risk has only recently been introduced in the literature (6), we considered the analysis of such data to be relevant. A second limitation is that environmental contamination was not evaluated at that time, although it may have played a role in the observed results (15-18).…”

Section: Discussionmentioning

confidence: 99%

Colonization pressure as a risk factor for colonization by multiresistant Acinetobacter spp and carbapenem-resistant Pseudomonas aeruginosa in an intensive care unit

DalBen¹,

Basso²,

García³

et al. 2013

Clinics

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OBJECTIVE:To determine factors associated with colonization by carbapenem-resistant Pseudomonas aeruginosa and multiresistant Acinetobacter spp.METHODS:Surveillance cultures were collected from patients admitted to the intensive care unit at admission, on the third day after admission and weekly until discharge. The outcome was colonization by these pathogens. Two interventions were implemented: education and the introduction of alcohol rubs. Compliance with hand hygiene, colonization pressure, colonization at admission and risk factors for colonization were evaluated.RESULTS:The probability of becoming colonized increased during the study. The incidence density of colonization by carbapenem-resistant P. aeruginosa and multiresistant Acinetobacter spp. and colonization pressure were different between periods, increasing gradually throughout the study. The increase in colonization pressure was due to patients already colonized at admission. The APACHE II score, colonization pressure in the week before the outcome and male gender were independent risk factors for colonization. Every 1% increase in colonization pressure led to a 2% increase in the risk of being colonized.CONCLUSION:Colonization pressure is a risk factor for carbapenem-resistant P. aeruginosa and multiresistant Acinetobacter spp. colonization. When this pressure reaches critical levels, efforts primarily aimed at hand hygiene may not be sufficient to prevent transmission.

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Colonization pressure and risk factors for acquisition of imipenem-resistant Acinetobacter baumannii in a medical surgical intensive care unit in Brazil

Cited by 24 publications

References 10 publications

Incidence, risk factors and outcome of multi-drug resistant Acinetobacter baumannii nosocomial infections during an outbreak in a burn unit

Incidence, risk factors and outcome of multi-drug resistant Acinetobacter baumannii nosocomial infections during an outbreak in a burn unit

Antimicrobial resistance profiles and oxacillinase genes in carbapenem-resistant Acinetobacter baumannii isolated from hospitalized patients in Santa Catarina, Brazil

Colonization pressure as a risk factor for colonization by multiresistant Acinetobacter spp and carbapenem-resistant Pseudomonas aeruginosa in an intensive care unit

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