Abstract
BackgroundFollowing 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.MethodsThe 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.ResultsFollowing 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).ConclusionsThe 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.
Highlights
Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged globally as a significant and difficult-to-treat nosocomial pathogen among critically ill patients [1]
We present the results of an intervention to terminate an outbreak of carbapenem-resistant Acinetobacter baumanii (CRAB) in the intensive care unit (ICU), long-term follow-up, and associated changes in CRAB prevalence throughout the hospital
ICU acquisition of CRAB decreased significantly from 54.6 cases/1000 admissions (28 cases) during the year prior to the intervention to 1.9 cases/1000 admissions (1 case) in the year following and to 5.6 cases/1000 admissions (3 patients) 2 years postintervention (p < 0.01 for comparisons with preintervention period). This decrease was accompanied by a significant decrease in ICU prevalence of CRAB (Table 1)
Summary
Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged globally as a significant and difficult-to-treat nosocomial pathogen among critically ill patients [1]. Numerous hospital outbreaks in intensive care units (ICUs) have been reported [2,3,4,5]. Acinetobacter outbreak termination is difficult to achieve, requiring patient screening and isolation strategies along with strict and Sisyphic environmental cleaning [6]. We present the results of an intervention to terminate an outbreak of CRAB in the ICU, long-term follow-up, and associated changes in CRAB prevalence throughout the hospital. 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 longterm changes in the incidence and prevalence of CRAB
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