Outbreak of resistant Acinetobacter baumannii: measures and proposal for prevention and control

Brazilian Journal of Infectious Diseases

Roberta Maia De Castro Romanelli²  Lenize Adriana De Jesus²  Wanessa Trindade Clemente²  Stella Sala Soares Lima²  Edna Maria Rezende¹  Rosane Luiza Coutinho²  Ricardo Luiz Fontes Moreira²  Francelli Aparecida Cordeiro Neves²  Nelma De Jesus Brás² 

[1] ,Universidade Federal de Minas Gerais Hospital das Clínicas Comissão de Controle de Infecção Hospitalar

关键词: Acinetobacter baumannii;    multidrug resistance;    carbapenem;    infection control;    outbreak;   

DOI  :  10.1590/S1413-86702009000500005

来源: SciELO

【 摘 要 】

Acinetobacter baumannii colonization and infection, frequent in Intensive Care Unit (ICU) patients, is commonly associated with high morbimortality. Several outbreaks due to multidrug-resistant (MDR) A. baumanii have been reported but few of them in Brazil. This study aimed to identify risk factors associated with colonization and infection by MDR and carbapenem-resistant A. baumannii strains isolated from patients admitted to the adult ICU at HC/UFMG. A case-control study was performed from January 2007 to June 2008. Cases were defined as patients colonized or infected by MDR/carbapenem-resistant A. baumannii, and controls were patients without MDR/carbapenem-resistant A. baumannii isolation, in a 1:2 proportion. For statistical analysis, due to changes in infection control guidelines, infection criteria and the notification process, this study was divided into two periods. During the first period analyzed, from January to December 2007, colonization or infection by MDR/carbapenem-resistant A. baumannii was associated with prior infection, invasive device utilization, prior carbapenem use and clinical severity. In the multivariate analysis, prior infection and mechanical ventilation proved to be statistically significant risk factors. Carbapenem use showed a tendency towards a statistical association. During the second study period, from January to June 2008, variables with a significant association with MDR/carbapenem-resistant A. baumannii colonization/infection were catheter utilization, carbapenem and third-generation cephalosporin use, hepatic transplantation, and clinical severity. In the multivariate analysis, only CVC use showed a statistical difference. Carbapenem and third-generation cephalosporin use displayed a tendency to be risk factors. Risk factors must be focused on infection control and prevention measures considering A. baumanni dissemination.

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