The Impact of Antimicrobial Stewardship and Infection Control Interventions on Acinetobacter baumannii Resistance Rates in the ICU of a Tertiary Care Center in Lebanon

Abstract

Antimicrobial resistance is a serious threat to global health, causing increased mortality and morbidity especially among critically ill patients. This toll is expected to rise following the COVID-19 pandemic. Carbapenem-resistant Acinetobacter baumannii (CRAb) is among the Gram-negative pathogens leading antimicrobial resistance globally; it is listed as a critical priority pathogen by the WHO and is implicated in hospital-acquired infections and outbreaks, particularly in critically ill patients. Recent reports from Lebanon describe increasing rates of infection with CRAb, hence the need to develop concerted interventions to control its spread. We set to describe the impact of combining antimicrobial stewardship and infection control measures on resistance rates and colonization pressure of CRAb in the intensive care units of a tertiary care center in Lebanon before the COVID-19 pandemic. The antimicrobial stewardship program introduced a carbapenem-sparing initiative in April 2019. During the same period, infection control interventions involved focused screening, monitoring, and tracking of CRAb, as well as compliance with specific measures. From January 2018 to January 2020, we report a statistically significant decrease in carbapenem consumption and a decrease in resistance rates of isolated A. baumannii. The colonization pressure of CRAb also decreased significantly, reaching record low levels at the end of the intervention period. The results indicate that a multidisciplinary approach and combined interventions between the stewardship and infection control teams can lead to a sustained reduction in resistance rates and CRAb spread in ICUs.

64: Bacterial Respiratory Infections in Patients With Covid-19: A Retrospective Study From a Tertiary Care Center in Lebanon

“…6). In fact, several ICU clusters and outbreaks of A. baumannii were reported at our institution in the pre-COVID era and were successfully contained by the ICPP (20,21). The consistent implementation of strict infection control measures throughout the pandemic, as evidenced by the absence of outbreaks or clusters during this period, likely explains the drop in A. baumannii burden observed in COVID-19 VAP relative to pre-COVID cases.…”

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

“…The issue of therapy to control CRAB must be addressed as selective pressure and carbapenem sparing [ 47 ]. For this very reason, 7 out of 12 of the papers reviewed focused on antimicrobial stewardship, and especially focused on the carbapenem sparing part, reducing, in all cases, the prevalence of CRAB.…”

Prescription of Choreito, a Japanese Kampo Medicine, with Antimicrobials for Treatment of Acute Cystitis: A Retrospective Cohort Study

“…However, this could not be proven in the present study. The review papers analyzing the COVID-19 pandemic outbreak and antibiotic administration in non-COVID-19-infected patients reported mixed results of decreased or increased antibiotic use; therefore, definitive conclusions could not be drawn [ 29 , 30 , 31 , 32 ].…”