A multimodal intervention program to control a long-term Acinetobacter baumannii endemic in a tertiary care hospital

Abstract

BackgroundAcinetobacter baumannii causes frequently nosocomial infections worldwide. Its ability to survive on dry surfaces facilitates its spread and the persistence of endemic situations, especially in the intensive care units (ICUs).The objective of this paper is to describe a multicomponent intervention program designed to control a hyperendemic persistence of multidrug-resistant A. baumannii (MDR-Ab) and to characterize its impact.MethodsDesign: Quasi-experimental intervention study based on open cohorts.Setting: Public tertiary referral centre. Period: January 2009–August 2017.Intervention: multifaceted program based on environmental decontamination, hand hygiene, antimicrobial stewardship, contact precautions, active surveillance, weekly reports and regular meetings.Analysis: joinpoint regression and interrupted time-series analysis.ResultsThe intervention was successfully implemented. Through the study period, the compliance with contact precautions changed from 0 to 100% and with hand hygiene, from 41.8 to 82.3%. Between 2012 and 2016, the antibiotic consumption decreased from 165.35 in to 150.44 daily-defined doses/1000 patients-days in the ICU. The incidence density of MDR-Ab in the ICU was 10.9 cases/1000 patients-days at the beginning of the intervention. After this moment, the evolution of the incidence density of MDR-Ab was: between months 0 and 6°, it remained stable; between months 7° and 10°: there was an intense decrease, with an average monthly percentage change (AMPC) = − 30.05%; from 11° month until the end, the decrease was lighter but continuous (AMPC:-2.77%), achieving an incidence density of 0 cases/1000 patients-days on the 18° month, without any new case for 12 months. From the 30° month until the end of the study period, several little outbreaks of MDR-Ab were detected, all of them rapidly controlled. The strains of MDR-Ab isolated during these outbreaks were not clonally related with the previously endemic one, which supports its eradication from the environmental reservoirs.ConclusionThe multicomponent intervention performed by a multidisciplinary team was effective to eradicate the endemic MDR-Ab.

Bacterial survival on inanimate surfaces: a field study

“…This is of importance as antibiotic resistant strains of those two particular species were recently classified as high priority ( E. faecium ) of even critical priority ( A. baumannii ) for health-care settings by the WHO [ 18 ]. Long-term transmission via environmental contamination in the endemic setting and several outbreaks caused by A. baumannii [ 19 – 22 ] and E. faecium [ 23 – 25 ] are extensively described in the medical literature. Furthermore, D'Sousa et al identified that A. baumannii and E. faecium even establish synergistic biofilms in vitro when co-cultured [ 26 ], which increases the likelihood of prolonged persistence and will facilitate further spread.…”

Carbapenem resistance in Acinetobacter baumannii , and their importance in hospital‐acquired infections: a scientific review

“…ICU wards should be periodically closed several times a year for terminal cleaning or temporarily closed when the ward is affected in order to terminate an outbreak. Every time a colonized patient is discharged, all bedside of the ICU and the rooms in other adjacent wards should also be terminally cleaned (Garnacho-Montero et al 2015;Valencia-Mart ın et al 2019). Hypochlorite-based disinfectants (at least 0Á5% concentration) may be used for decontamination of non-disposable medical products (Garnacho-Montero et al 2015).…”

Adaptations of carbapenem resistant Acinetobacter baumannii (CRAB) in the hospital environment causing sustained outbreak

“…In one of the previous studies in the same setup, it was revealed that nearly 93 % of all the isolates of A. baumannii from clinical samples of patients in the ICU carried bla OXA-23 followed by bla IMP (89 %) and bla VIM (51 %), while CRAB was also commonly isolated from the ICU environment [5]. Environment contamination with MDR A. baumannii has accounted for several recurrent outbreaks in the hospitals [23]. Complete eradication of this nosocomial reservoir of CRAB has been almost impossible despite continued efforts [24].…”

“…Environment contamination with MDR A. baumannii has accounted for several recurrent outbreaks in the hospitals [23]. Complete eradication of this nosocomial reservoir of CRAB has been almost impossible despite continued efforts [24].…”