<p>Successful Incidences of Controlling Multidrug-Resistant, Extensively Drug-Resistant, and Nosocomial Infection <em>Acinetobacter baumannii</em> Using Antibiotic Stewardship, Infection Control Programs, and Environmental Cleaning at a Chinese University Hospital</p>

Abstract

Objective: We estimated the efficacy of antimicrobial stewardship (AMS), infection control programs (ICP), and environmental cleaning (ENC) for controlling the resistance of Acinetobacter baumannii (AB) and controlling the incidence of multidrug-resistant AB (MDRAB), extensively drug-resistant AB (XDRAB), and nosocomial infection AB in the ICU (NIAB-ICU) at a university hospital. Methods: The intervention included 4-year AMS+ICP and 3-year AMS+ICP+ENC between January 2012 and December 2019. Results: A total of 2636 AB isolates were collected totally, and 64.98% of AB isolates were MDR and 29.97% were XDR. Preintervention and postintervention incidences of MDRAB, XDRAB, and NIAB-ICU by AMS+ICP measures ranged from 84.96% to 71.98%, 41.96% to 33.13%, and 45.6% to 38%, respectively. However, all of them were not statistically changed (P=0.085, 0.072, 0.061, separately). The preintervention and postintervention incidences of MDRAB, XDRAB, and NIAB-ICU by AMS+ICP+ENC measures ranged from 71.98% to 36.55%, 33.13% to 19.88%, and 38% to 22.5%, respectively. Statistically significant declines were observed (P=0.016, 0.041, 0.032, separately). The defined daily doses (DDD) per 1000 patient-days (PD) decreased from 45±3.3 to 30.81±1.5 per 1000 PD across from 2012 to 2019, and a statistical decline was seen (P=0.01). Concurrently, the alcohol-based hand gel (ABHG) consumption per 1000 PD increased from 0.6±0.05 L to 12.5±2.3 L per 1000 PD, and a statistical increase was observed (P=0.0001). A statistically positive correlation was revealed between the DDD and incidence of MDRAB, XDRAB, and NIAB-ICU (r=0.905 and p=0.002; r=0.939 and p=0.001; r=0.956 and p=0.0002; respectively). Simultaneously, a statistically negative correlation was showed between the ABHG and incidence of MDRAB, XDRAB, and NIAB-ICU (r= −0.858 and p=0.006; r=−0.888 and p=0.003; r=−0.882 and p=0.004, separately). Conclusion: The AMS, ICP, and ENC may be one of the most effective and best measures to address the increasing incidence of MDRAB, XDRAB, and NIAB-ICU currently.

Pharmacy Infection Control: Environmental and Workplace Policy

“…Carpeting and cloth furnishings. [1][2][3]8,10,[26][27][28][29][30][31] 1. Use good-maintained equipment to minimize dust when vacuum carpeting.…”

Systematic Review: Implementasi dan Dampak Antimicrobial Stewardship Program pada Fasilitas Kesehatan di Berbagai Negara

“…High-income Economies (n) NA India (n=2) 17,18 China (n=3) [20][21][22] Jepang (n=4) [26][27][28][29] Iran (n=1) 19 Thailand (n=2) 23,24 Singapura (n=1) 30 Afrika selatan (n=1) 25 Taiwan (n=3) [31][32][33] Kanada (n=1) 34 Spanyol (n=1) 35 Yunani (n=1) 36 Italia (n=1) 37 Saudi arabia (n=1) 38 Keterangan; NA=Not-Available Pencarian awal Pubmed (n=322) Cochrane Library (n=152) Skrining Judul/Abstrak…”

“…Penelitian terkait implementasi ASP pada artikel terpilih, sebagian besar dilakukan tidak pada bangsal perawatan khusus (n=17) dan hanya lima penelitian yang dilakukan khusus di ruang perawatan intensif (ICU). 17,[20][21][22]32 39 Selain itu, basis data pencarian yang digunakan dalam systematic review ini hanya Pubmed dan Cochrane Library, sehingga memungkinkan untuk tidak ditemukannya artikel terkait ASP yang dipublikasikan dalam bahasa Indonesia atau yang diterbitkan pada jurnal dengan bahasa Indonesia. Namun tidak dapat disimpulkan bahwa proses pencarian pustaka dalam systematic review ini tidak dilakukan secara komprehensif, karena basis data tersebut merupakan salah satu basis data terbaik untuk memuat artikel penelitian kesehatan yang berkualitas dari berbagai negara, termasuk Indonesia.…”

“…Namun strategi tersebut juga dikombinasikan dengan strategi lainnya yaitu satu penelitian dengan Prospective audit with intervention and feedback dan infection control program serta satu penelitian dengan infection control program dan environment cleaning. 20,22…”

Surveillance cultures following a regional outbreak of carbapenem-resistant Acinetobacter baumannii

“…[11][12][13][14] Facilities have implemented infection control measures, such as surveillance, to control its spread. [15][16][17][18][19][20][21] Although surveillance aims to identify asymptomatic carriers, [10][11][12]14 uncertainty remains regarding how long after an outbreak this surveillance should be performed.…”