Effects of infection control measures on acquisition of five antimicrobial drug-resistant microorganisms in a tetanus intensive care unit in Vietnam

Abstract

PurposeTo quantify the effects of barrier precautions and antibiotic mixing on prevalence and acquisition of five drug-resistant microorganisms within a single tetanus intensive care unit at a tertiary referral hospital in Ho Chi Minh City, Vietnam.MethodsAll patients admitted within the study period were included. After a 1-year baseline period, barrier precautions were implemented and the single empirical treatment ceftazidime was changed to mixing (per consecutive patient) of three different regimens (ceftazidime, ciprofloxacin, piperacillin–tazobactam). Markov chain modeling and genotyping were used to determine the effects of interventions on prevalence levels and the relative importance of cross-transmission and antibiotic-associated selection.ResultsA total of 190 patients were included in year 1 (2,708 patient days, 17,260 cultures) and 167 patients in year 2 (3,384 patient days, 20,580 cultures). In year 1, average daily prevalence rates for methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (excluding Klebsiella pneumoniae), Pseudomonas aeruginosa, gentamicin-resistant K. pneumoniae, and amikacin-resistant Acinetobacter species were 34.0, 61.3, 53.4, 65.7 and 57.1 %. After intervention, ceftazidime usage decreased by 53 %; the use of piperacillin–tazobactam and ciprofloxacin increased 7.2-fold and 4.5-fold, respectively. Adherence to hand hygiene after patient contact was 54 %. These measures were associated with a reduction of MRSA prevalence by 69.8 % (to 10.3 %), mainly because of less cross-transmission (88 % reduction), and of ESBL-producing Enterobacteriaceae prevalence by 10.3 % (non-significantly). In contrast, prevalence levels of the other three pathogens remained unaffected.ConclusionThe combination of simple infection control measures and antibiotic mixing was highly effective in reducing the prevalence of MRSA, but not of Gram-negative microorganisms.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-012-2771-1) contains supplementary material.

Prevention and control of multi-drug-resistant Gram-negative bacteria: recommendations from a Joint Working Party

“…However, this study did not include physical segregation of patients or the use of gowns or aprons. 218 Various studies have evaluated switching from a multioccupancy ward to a single-occupancy ward. An Israeli study showed that there were significantly fewer acquisitions of resistant organisms when an ICU was converted from a multioccupancy bay to single rooms.…”

Controversies in guidelines for the control of multidrug-resistant Gram-negative bacteria in EU countries

“…Contact (and droplet) precautions and single rooms Contact precautions, defined herein as the use of personal protective equipment such as gloves and gowns and clear signage, can be delivered in either a multi-occupancy bay or single-room setting. There is evidence from studies in endemic settings that applying contact precautions can help to prevent the transmission of MDR-GNB [4,[13][14][15][16][17][18]. The use of single rooms for patients with MDR-GNB is a distinct but related intervention.…”

Gut Microbiota, Antibiotic Therapy and Antimicrobial Resistance: A Narrative Review

“…The implementation of these measures has been shown to significantly reduce hospital costs and the use of antibiotics [19]. However, at an individual level, few studies have shown a link between a decrease in broad-spectrum antibiotic consumption and a decrease in antimicrobial resistance [20][21][22]. A study conducted in an intensive care unit found no decrease in the rate of global multidrug resistant (MDR) strain carriage acquisition after de-escalation of pivotal beta-lactam in ventilator-associated pneumoniae [23].…”