Management of carbapenem-resistant Acinetobacter baumannii epidemic in an intensive care unit using multifaceted intervention strategy

Abstract

Background/AimsWe evaluated the effects of a multifaceted intervention for controlling a carbapenem-resistant Acinetobacter baumannii (CRAB) epidemic in an intensive care unit (ICU) with no restrictions on carbapenem use.MethodsThis study was conducted in a medical ICU between April 2012 and June 2016. The baseline infection control programs included surveillance cultures, contact precautions, and environmental cleaning. However, increases in the detection of CRAB isolates beginning in May 2013 led to the implementation of a new protocol, consisting of universal glove and gown use with daily chlorhexidine bathing for all patients in combination with baseline programs. The efficacy of the intervention was subjected to interrupted time series (ITS) analysis.ResultsThe multifaceted intervention led to a decrease in the incidence of CRAB from 17.65 to 0.89 cases per 1,000 patient-days, during the study period (p < 0.001). ITS analysis revealed a significant change in the trend of CRAB incidence (–0.413, p < 0.001). Over this same period, mean monthly use of carbapenems increased from 143.54 ± 95.73 to 204.95 ± 78.43 doses per 1,000 patient-days (p = 0.018).ConclusionsOur multifaceted intervention reduced the incidence of CRAB acquisition in an ICU where carbapenem use was not restricted.

Control of a hospital-wide outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) using the Israeli national carbapenem-resistant Enterobacteriaceae (CRE) guidelines as a model

“…24 CRAB outbreaks are notoriously difficult to control, mostly due to carriage persistence 23 in parallel with the characteristic, prolonged hospitalization of carriers and survival of the bacteria in the environment. Our intervention, like others 25,26 demonstrates that, by using a multifaceted infection control program, marked reduction in CRAB acquisition, accompanied by interruption of CRAB transmission can be achieved. Such an intervention, demanding increased manpower and resources, could not have been executed without hospital and ward management support.…”

“…Successful interventions in reducing CRAB have been published previously, [25][26][27] but their focus was mostly in ICUs. One study from Korea described a hospital-wide intervention focusing on hand hygiene campaign and cohorting patients with CRAB.…”

Challenges for adherence to bacterial resistance actions in large hospitals

“…The use of standard plus contact precautions, associated to the cleaning of the environment, have been pointed out as multifaceted strategies to reduce the dissemination of resistant microorganisms in ICUs. To this end, the need to develop practices to encourage adhering to these practices in health institutions is reiterated (2,23) .…”

<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>

“…Many studies have found it crucial. 39 Australia's first National Antimicrobial Resistance policy for 2015～2019 mentions the demand for resources to sustain the implementation of AMS in all hospitals. 40 One study revealed that the incidence of MDRAB was addressed by controlling the inappropriate duration of antimicrobial treatments and the misuse of carbapenems.…”