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Young Ah Kim1
, Yoon Soo Park2, Sang Sun Lee1, Young Jun Son1, Jeong Hwa Yeon3, Young Hee Seo4, Kyungwon Lee4, 5
, Yoon Soo Park2, Sang Sun Lee1, Young Jun Son1, Jeong Hwa Yeon3, Young Hee Seo4, Kyungwon Lee4, 5
Abstract
Background
Acinetobacter baumannii is a well-known etiologic agent of a variety of nosocomial infections; the resistance rate to imipenem is surprisingly high in Korea. The colonization of carbapenem-resistant A. baumannii (CRAB) is known to be associated with increased mortality, hospital stay, and cost in intensive care unit (ICU)-admitted patients. In this study, the prevalence, molecular epidemiology, and risk factors of CRAB colonization were evaluated in ICU settings that did not have a current outbreak.
Methods
Consecutive screening for the colonization of CRAB was performed with 291 patients admitted to the surgical or medical ICU within 48 hours for six months (from April to September 2017) in one general hospital (817 beds, Goyang-si, Gyeonggi-do province, Korea). An active surveillance culture (ASC) for CRAB was performed according to the Centers for Disease Control and Prevention protocols with a perirectal swab sample. After DNA extraction, multiplex PCR was performed to detect carbapenemase genes (blaOXA-23-like, blaOXA-24-like, blaOXA-51-like, blaOXA-58-like, ISAba1-blaOXA-23-like, and ISAba1-blaOXA-51-like gene). A case-control study was performed to evaluate the risk factors.
Figures and Tables
Fig. 1
PFGE patterns of carbapenem-resistant A. baumannii (CRAB) colonizers (N=14*) isolated from intensive care unit-admitted patients and A. baumannii (N=6) isolated from patients with bloodstream infections. The dendrogram was generated by InfoQuest FP software (Bio-Rad) using UPGMA from the Dice coefficient with 1% band position tolerance and 0.5% optimization settings. *One isolate (AB038) was excluded due to repeated failure of re-culture.
Abbreviation: ASC, active surveillance culture.
Fig. 2
Resistant rates (%) of carbapenem-resistant A. baumannii, colonizers, isolated from intensive care unit-admitted patients (N=15).
Table 1
Risk factors of OXA-23-producing Acinetobacter baumannii colonization at ICU admission: univariate analysis
Table 2
Summary of recommendations for the prevention and control of CRAB*
Abbreviations: CRAB, carbapenem-resistant Acinetobacter baumannii; IPC, infection prevention and control; WHO, World Health Organization.
*This table was modified from WHO guidelines for the prevention and control of carbapenem-resistant organisms [17].
**Quality of evidence was classified as high, moderate, low, or very low according to factors that include the study methodology, consistency and precision of the results, and directness of the evidence.
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