Is It Possible to Eradicate Carbapenem-Resistant Acinetobacter baumannii (CRAB) from Endemic Hospitals?

Abstract

Background: Despite the global efforts to antagonize carbapenem-resistant Acinetobacter baumannii (CRAB) spreading, it remains an emerging threat with a related mortality exceeding 40% among critically ill patients. The purpose of this review is to provide evidence concerning the best infection prevention and control (IPC) strategies to fight CRAB spreading in endemic hospitals. Methods: The study was a critical review of the literature aiming to evaluate all available studies reporting IPC measures to control CRAB in ICU and outside ICU in both epidemic and endemic settings in the past 10 years. Results: Among the 12 included studies, the majority consisted of research reports of outbreaks mostly occurred in ICUs. The reported mortality reached 50%. Wide variability was observed related to the frequency of application of recommended CRAB IPC measures among the studies: environmental disinfection (100%); contact precautions (83%); cohorting staff and patients (75%); genotyping (66%); daily chlorhexidine baths (58%); active rectal screening (50%); closing or stopping admissions to the ward (33%). Conclusions: Despite effective control of CRAB spreading during the outbreaks, the IPC measures reported were heterogeneous and highly dependent on the different setting as well as on the structural characteristics of the wards. Reinforced ‘search and destroy’ strategies both on the environment and on the patient, proved to be the most effective measures for permanently eliminating CRAB spreading.

Gastrointestinal Colonization of Carbapenem-Resistant Acinetobacter baumannii: What Is the Implication for Infection Control?

“…Control of CRAB infections in endemic hospitals remains a challenge. In addition to hand hygiene as a core component of infection prevention and control, active surveillance cultures, contact precautions, cohorting patients, environmental disinfection, use of chlorhexidine baths, and closing or stopping admissions to the ward have been adopted to eradicate CRAB infections from endemic hospitals, as illustrated in a recent review [ 7 ].…”

Genomic Characterization of Carbapenem-Resistant Acinetobacter baumannii (CRAB) in Mechanically Ventilated COVID-19 Patients and Impact of Infection Control Measures on Reducing CRAB Circulation during the Second Wave of the SARS-CoV-2 Pandemic in Milan, Italy

“…Over the last years, several IPC measures have been recommended to manage CRAB outbreaks in the ICU. A recent review of 12 studies conducted over the last 10 years in settings where CRAB transmission is both epidemic and endemic found wide variability in the frequency of application of IPC measures ( 28 ). While all studies adopted a multimodal approach, the most frequently applied strategies (75 to 100% of studies) resulted in environmental disinfection, contact precautions, and cohorting of staff and patients.…”

Molecular Epidemiology of Clinical Carbapenem-Resistant Acinetobacter baumannii-calcoaceticus complex Isolates in Tertiary Care Hospitals in Java and Sulawesi Islands, Indonesia

“…Infections included about 8500 cases of nosocomial infection, and as many as 700 such deaths were related to antibiotic resistance [ 13 ]. Multiple studies revealed that carbapenem-resistant A. baumannii isolates were frequently isolated among patients with pneumonia, followed by patients with bloodstream infections and urinary tract infections, particularly in the intensive care unit (ICU) [ 14 , 15 , 16 ]. The prevalence of carbapenem-resistant A. baumannii varies between 30% in USA and 94% in Greece [ 16 ].…”

“…Multiple studies revealed that carbapenem-resistant A. baumannii isolates were frequently isolated among patients with pneumonia, followed by patients with bloodstream infections and urinary tract infections, particularly in the intensive care unit (ICU) [ 14 , 15 , 16 ]. The prevalence of carbapenem-resistant A. baumannii varies between 30% in USA and 94% in Greece [ 16 ]. A multicenter study in Indonesia reported that the prevalence of carbapenem-resistant A. baumannii bloodstream infections increased from 49% in 2016 to 57% in 2018 [ 17 ].…”

“…In addition, the selective pressure at the genomic level and gene transfer mediated by highly transmissible plasmids occur while bacteria survive in the hospital [ 4 , 20 , 21 ]. These events might be associated with the outbreak of carbapenem-resistant Acinetobacter baumanii , particularly in the ICU setting [ 16 ].…”