Acute Crit Care.  2018 Nov;33(4):238-245. 10.4266/acc.2018.00220.

Intensive Care Unit Relocation and Its Effect on Multidrug-Resistant Respiratory Microorganisms

Affiliations
  • 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. realrain7@gmail.com
  • 2Infection Control Center, Seoul National University Hospital, Seoul, Korea.

Abstract

BACKGROUND
Infection by multidrug-resistant (MDR) pathogens leads to poor patient outcomes in intensive care units (ICUs). Contact precautions are necessary to reduce the transmission of MDR pathogens. However, the importance of the surrounding environment is not well known. We studied the effects of ICU relocation on MDR respiratory pathogen detection rates and patient outcomes.
METHODS
Patients admitted to the ICU before and after the relocation were retrospectively analyzed. Baseline patient characteristics, types of respiratory pathogens detected, antibiotics used, and patient outcomes were measured.
RESULTS
A total of 463 adult patients admitted to the ICU, 4 months before and after the relocation, were included. Of them, 234 were admitted to the ICU before the relocation and 229 afterward. Baseline characteristics, including age, sex, and underlying comorbidities, did not differ between the two groups. After the relocation, the incidence rate of MDR respiratory pathogen detection decreased from 90.0 to 68.8 cases per 1,000 patient-days, but that difference was statistically insignificant. The use of colistin was significantly reduced from 53.5 days (95% confidence interval [CI], 20.3 to 86.7 days) to 18.7 days (95% CI, 5.6 to 31.7 days). Furthermore, the duration of hospital stay was significantly reduced from a median of 29 days (interquartile range [IQR], 14 to 50 days) to 21 days (IQR, 11 to 39 days).
CONCLUSIONS
Incidence rates of MDR respiratory pathogen detection were not significantly different before and after ICU relocation. However, ICU relocation could be helpful in reducing the use of antibiotics against MDR pathogens and improving patient outcomes.

Keyword

environment; intensive care units; multiple drug resistance

MeSH Terms

Adult
Anti-Bacterial Agents
Colistin
Comorbidity
Critical Care*
Drug Resistance, Multiple
Humans
Incidence
Intensive Care Units*
Length of Stay
Retrospective Studies
Anti-Bacterial Agents
Colistin

Figure

  • Figure 1. Changes in multidrug-resistant (MDR) microorganisms from the respiratory tract before and after the medical intensive care unit relocation. Bars indicate 95% confidence intervals. CRAB: carbapenem-resistant Acinetobacter baumannii; MRSA: methicillin-resistant Staphylococcus aureus; ESBL: extended-spectrum β-lactamase; CRPA: carbapenem-resistant Pseudomonas aeruginosa.

  • Figure 2. Monthly incidence rates of multidrug-resistant (MDR) microorganisms from the respiratory tract. CRAB: carbapenem-resistant Acinetobacter baumannii; MRSA: methicillin-resistant Staphylococcus aureus; MICU: medical intensive care unit.

  • Figure 3. Changes in use of antibiotics before and after the medical intensive care unit relocation. Bars indicate 95% confidence intervals. *Statistical significance with P<0.05.


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