Korean J Nosocomial Infect Control.  2009 Dec;14(2):72-78.

The Analysis of Risk Factor and Infection Control of Carbapenem-Resistant Acinetobacter baumannii in a Medical Intensive Care Unit

• Moon SM
• Son JS
• Lee HJ
• Chun HK
• Kim ML
• Lee MS

Abstract

BACKGROUND
An epidemiologic study was performed after the outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) in the medical intensive care unit (MICU) from December 2006 to May 2007.
METHODS
A retrospective case-control study was performed using the medical records of the patients. The case and control patients were compared for age, gender, total length of stay in MICU, prior carbapenem use, Acute Physiology and Chronic Health Evaluation II (APACH II) score, presence of central line, effect of mechanical ventilation, and sputum suction. Environmental and hand-washing studies were performed during the outbreak.
RESULTS
Ten CRAB-affected patients and 29 controls were enrolled in this study. Univariate analysis showed that the age, total length of stay in MICU, presence of central line, and prior carbapenem use were associated with the CRAB outbreak. However, multivariate analysis showed that only prior carbapenem use was associated with the CRAB outbreak (odd ratio: 8.67, P=0.01). The outbreak disappeared after implementing a combined infection control strategy, including the sequential disinfection of MICU and strict compliance with cross-transmission prevention protocols.
CONCLUSION
The use of carbapenem was associated with an increased risk of CRAB infection. This study suggests that the MICU contamination and infection transmission by health-care workers played a major role in the CRAB outbreak. Novel strategies such as restricted use of broad-spectrum antibiotics, strict hand hygiene, strict isolation of the patients, and MICU disinfection may be required to prevent the CRAB outbreak.

Keyword

Acinetobacter baumannii; Carbapenem resistance; Intensive care unit

MeSH Terms

Acinetobacter
Acinetobacter baumannii
Anti-Bacterial Agents
APACHE
Case-Control Studies
Compliance
Disease Transmission, Infectious
Disinfection
Epidemiologic Studies
Hand Hygiene
Humans
Infection Control
Critical Care
Intensive Care Units
Length of Stay
Medical Records
Multivariate Analysis
Respiration, Artificial
Retrospective Studies
Risk Factors
Sputum
Suction
Anti-Bacterial Agents