Active surveillance for carbapenem-resistant Acinetobacter baumannii in a medical intensive care unit: Can it predict and reduce subsequent infections and the use of colistin?

被引:32
作者
An, Joon Hwan [1 ]
Kim, Yu-Hyoung [2 ]
Moon, Jeong-Eun [2 ]
Jeong, Jong Hae [2 ]
Kim, Soo-Hyun [3 ]
Kang, Seung-Ji [1 ]
Park, Kyung-Hwa [1 ]
Jung, Sook-In [1 ]
Jang, Hee-Chang [1 ,2 ]
机构
[1] Chonnam Natl Univ, Dept Infect Dis, Med Sch, 671 Jebong Ro, Gwang Ju 501757, South Korea
[2] Hwasun Chonnam Nationality Univ Hosp, Infect Control Off, Hwasun, South Korea
[3] Chonnam Natl Univ, Med Sch, Dept Lab Med, Gwang Ju, South Korea
关键词
Precaution; Incidence; Isolation; OUTBREAK; EPIDEMIOLOGY; SURVIVAL; CULTURES;
D O I
10.1016/j.ajic.2017.01.016
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: Infection caused by carbapenem-resistant Acinetobacter baumannii (CRAB) has become a major problem in intensive care units (ICUs), with high incidence and mortality. This prospective study investigated the diagnostic value and influence of active surveillance, followed by isolation and enhanced contact precaution (IECP), on the subsequent CRAB infection and colistin use. Methods: The study prospectively enrolled 1,115 patients who were admitted to the medical ICU of Chonnam National University Hwasun Hospital between April 2011 and November 2014. Active surveillance cultures were obtained from the throat or trachea, skin, and urine. IECP was performed beginning April 2013. Results: Active surveillance detected CRAB in 168 (15%) patients and CRAB infection developed in 70 (6%) patients. Endotracheal tube was independently associated with both CRAB colonization and infection, whereas IECP was inversely associated with both CRAB colonization and infection in multivariate analysis (all P values <.001). The sensitivity, specificity, and positive and negative predictive values of active surveillance for subsequent CRAB infection were 84%, 90%, 47%, and 98%, respectively. The rate of CRAB acquisition, CRAB infection, and the use of colistin were significantly lower during the IECP period compared with the control period (6.5 vs 34.1, 2.6 vs 14.7, and 19.9 vs 65.5 per 1,000 patient-days, respectively; all P <.001). Conclusions: Active surveillance has good specificity and negative predictive value for subsequent CRAB infection. Active surveillance followed by IECP was inversely associated with the acquisition of CRAB and subsequent CRAB infection, and was associated with a reduction in colistin use in ICU patients. (C) 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:667 / 672
页数:6
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