Long-term control of hospital-wide, endemic multidrug-resistant Acinetobacter baumannii through a comprehensive “bundle” approach
published online 20 May 2009.
Background
Acinetobacter baumannii (Ab) is emerging as a multidrug-resistant (MDR) nosocomial pathogen of considerable clinical importance. Data on the efficacy of infection control measures in endemic situations are lacking. Here, we investigated the impact of a long-term multifaceted “bundle” approach in controlling endemic MDR Ab in a 950-bed tertiary care center.
Methods
Ongoing staff education, promotion of hand hygiene, strict Contact and Isolation Precautions, environmental cleaning, and targeted active surveillance in high-risk areas during periods of likely transmission and contamination were initiated in this program. To assess the efficacy of our interventions, we recorded (before and after the intervention) the epidemiologic and clinical features of MDR Ab infections and determined the clonal relationship among MDR Ab bloodstream isolates by pulsed-field gel electrophoresis.
Results
Before the “bundle” was instituted, the rate of colonization/infection was 0.82 cases per 100 admissions (1994-1995). Colonization/infection rates showed a sustained decrease after implementation of the control program in 1995 to 0.46 in 1996-1997 and to 0.21 in 1998-2003 (P < .001). Coincident with the institution of this program, the rate of bacteremia because of MDR Ab decreased 6-fold during the 8-year observation period. A notable change in the clonal distribution of the MDR Ab isolates was also demonstrated.
Conclusion
The implementation of a comprehensive and multifaceted infection control program (“bundle”) in a tertiary care center effectively controlled the spread and clinical impact of MDR Ab.
aSección Enfermedades Infecciosas, Hospital Universitario Virgen Macarena and Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
bServicio de Microbiología, Hospital Universitario Virgen Macarena, and Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
cServicio de Farmacia, Hospital Universitario Virgen Macarena, Sevilla, Spain
dCase Western Reserve University, School of Medicine, Louis Stokes Veteran Affairs Medical Center, Cleveland, OH
Address correspondence to Robert A. Bonomo, MD, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH, 44106.
L.M-M.'s present address is Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Supported in part by the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III-FEDER, Spanish Network for the Research in Infectious Diseases (REIPI C03/14 and REIPI RD06/0008), and FIS PI051019; a fellowship from the Asociación Sanitaria Virgen Macarena (to C.M.); the Merit Review Award and Geriatric Research Education and Clinical Center VISN 10 from the Department of Veterans Affairs and the NIH (RO1 AI072219; to R.A.B.); AstraZeneca (to A.E.); and a Wyeth Fellowship in Antimicrobial Resistance (to F.P.).
ABSTRACT