An intervention to control an ICU outbreak of carbapenem-resistant Acinetobacter baumannii: long-term impact for the ICU and hospital
Tóm tắt
Following a fatal intensive care unit (ICU) outbreak of carbapenem-resistant Acinetobacter baumanii (CRAB) in 2015, an aggressive infection control intervention was instituted. We outline the intervention and long-term changes in the incidence and prevalence of CRAB. The infection control intervention included unit closure (3 days), environmental cleaning, hand hygiene interventions, and environmental culturing. CRAB acquisition and prevalence and colistin use were compared for the 1 year before and 2 years after the intervention. Following the intervention, ICU CRAB acquisition decreased significantly from 54.6 (preintervention) to 1.9 (year 1) to 5.6 cases (year 2)/1000 admissions (p < 0.01 for comparisons with preintervention period.). Unexpectedly, ICU CRAB admission prevalence also decreased from 56.5 to 5.8 to 13 cases/1000 admissions (p < 0.001) despite the infection control intervention’s being directed at the ICU alone. In parallel, hospital CRAB prevalence decreased from 4.4 to 2.4 to 2.5 cases/1000 admissions (p < 0.001), possibly as a result of decreased discharge of CRAB carriers from the ICU to the wards (58.5 to 1.9 to 7.4 cases/1000 admissions; p < 0.001). ICU colistin consumption decreased from 200 to 132 to 75 defined daily dose (DDD)/1000 patient-days (p < 0.05). Hospital colistin consumption decreased from 21.2 to 19.4 to 14.1 DDD/1000 patient-days (p < 0.05). The ICU infection control intervention was highly effective, long-lasting, and associated with a decrease in last-line antibiotic use. The intervention was associated with the unexpected finding that hospital CRAB prevalence also decreased.
Tài liệu tham khảo
Munoz-Price LS, Weinstein RA. Acinetobacter infection. N Engl J Med. 2008;358(12):1271–81.
Kohlenberg A, Brummer S, Higgins PG, Sohr D, Piening BC, de Grahl C, Halle E, Ruden H, Seifert H. Outbreak of carbapenem-resistant Acinetobacter baumannii carrying the carbapenemase OXA-23 in a German university medical centre. J Med Microbiol. 2009;58(Pt 11):1499–507.
Garlantezec R, Bourigault C, Boles JM, Prat G, Baron R, Tonnelier JM, Cosse M, Lefevre M, Jourdain S, Lelay G, et al. Cost-analysis of an intensive care unit closure due to an imipenem-resistant oxa-23 Acinetobacter baumannii outbreak. J Hosp Infect. 2011;77(2):174–5.
Ayraud-Thevenot S, Huart C, Mimoz O, Taouqi M, Laland C, Bousseau A, Castel O. Control of multi-drug-resistant Acinetobacter baumannii outbreaks in an intensive care unit: feasibility and economic impact of rapid unit closure. J Hosp Infect. 2012;82(4):290–2.
Molter G, Seifert H, Mandraka F, Kasper G, Weidmann B, Hornei B, Ohler M, Schwimmbeck P, Kroschel P, Higgins PG, et al. Outbreak of carbapenem-resistant Acinetobacter baumannii in the intensive care unit: a multi-level strategic management approach. J Hosp Infect. 2016;92(2):194–8.
Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev. 2008;21(3):538–82.
Blot S, Vandewoude K, Colardyn F. Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients: a matched cohort study. Intensive Care Med. 2003;29(3):471–5.
Garnacho J, Sole-Violan J, Sa-Borges M, Diaz E, Rello J. Clinical impact of pneumonia caused by Acinetobacter baumannii in intubated patients: a matched cohort study. Crit Care Med. 2003;31(10):2478–82.
Falagas ME, Kopterides P, Siempos II. Attributable mortality of Acinetobacter baumannii infection among critically ill patients. Clin Infect Dis. 2006;43(3):389 author reply 389–90.
Jones CL, Clancy M, Honnold C, Singh S, Snesrud E, Onmus-Leone F, McGann P, Ong AC, Kwak Y, Waterman P, et al. Fatal outbreak of an emerging clone of extensively drug-resistant Acinetobacter baumannii with enhanced virulence. Clin Infect Dis. 2015;61(2):145–54.
Levin PD, Shatz O, Sviri S, Moriah D, Or-Barbash A, Sprung CL, Moses AE, Block C. Contamination of portable radiograph equipment with resistant bacteria in the ICU. Chest. 2009;136(2):426–32.
Garcia LS, editor. Clinical microbiology procedures handbook. 3rd ed. Washington, DC: ASM Press; 2010.
Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing: twenty-first informational supplement. CLSI Document M100-S21. Wayne: CLSI; 2011.
Lesho E, Yoon EJ, McGann P, Snesrud E, Kwak Y, Milillo M, Onmus-Leone F, Preston L, St Clair K, Nikolich M, et al. Emergence of colistin-resistance in extremely drug-resistant Acinetobacter baumannii containing a novel pmrCAB operon during colistin therapy of wound infections. J Infect Dis. 2013;208(7):1142–51.
World Health Organization (WHO). WHO guidelines on hand hygiene in health-care: first global patient safety challenge: clean care is safer care. Geneva: WHO; 2009. http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdf. Accessed 29 May 2016
Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002;27(4):299–309.
Ansari F, Gray K, Nathwani D, Phillips G, Ogston S, Ramsay C, Davey P. Outcomes of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis. J Antimicrob Chemother. 2003;52(5):842–8.
Ramsay CR, Matowe L, Grilli R, Grimshaw JM, Thomas RE. Interrupted time series designs in health technology assessment: lessons from two systematic reviews of behavior change strategies. Int J Technol Assess Health Care. 2003;19(4):613–23.
Zahar JR, Blot S. Dilemmas in infection control in the intensive care unit. Intensive Crit Care Nurs. 2018;46:1–3.
Ling ML, Ang A, Wee M, Wang GC. A nosocomial outbreak of multiresistant Acinetobacter baumannii originating from an intensive care unit. Infect Control Hosp Epidemiol. 2001;22(1):48–9.
Markogiannakis A, Fildisis G, Tsiplakou S, Ikonomidis A, Koutsoukou A, Pournaras S, Manolis EN, Baltopoulos G, Tsakris A. Cross-transmission of multidrug-resistant Acinetobacter baumannii clonal strains causing episodes of sepsis in a trauma intensive care unit. Infect Control Hosp Epidemiol. 2008;29(5):410–7.
Levin PD, Golovanevski M, Moses AE, Sprung CL, Benenson S. Improved ICU design reduces acquisition of antibiotic-resistant bacteria: a quasi-experimental observational study. Crit Care. 2011;15(5):R211.
Bracco D, Dubois MJ, Bouali R, Eggimann P. Single rooms may help to prevent nosocomial bloodstream infection and cross-transmission of methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med. 2007;33(5):836–40.
Mulin B, Rouget C, Clement C, Bailly P, Julliot MC, Viel JF, Thouverez M, Vieille I, Barale F, Talon D. Association of private isolation rooms with ventilator-associated Acinetobacter baumanii pneumonia in a surgical intensive-care unit. Infect Control Hosp Epidemiol. 1997;18(7):499–503.
Stiller A, Salm F, Bischoff P, Gastmeier P. Relationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis. Antimicrob Resist Infect Control. 2016;5:51.
Karageorgopoulos DE, Falagas ME. Current control and treatment of multidrug-resistant Acinetobacter baumannii infections. Lancet Infect Dis. 2008;8(12):751–62.
Towner KJ. Acinetobacter: an old friend, but a new enemy. J Hosp infect. 2009;73(4):355–63.
Antunes LC, Visca P, Towner KJ. Acinetobacter baumannii: evolution of a global pathogen. Pathog Dis. 2014;71(3):292–301.