Major ArticleEmergence of resistant Acinetobacter baumannii in critically ill patients within an acute care teaching hospital and a long-term acute care hospital
Section snippets
Organism identification
Using standard commercial identification systems, 229 AB isolates were identified in the clinical microbiology laboratory between March 2003 and December 2004. Of the 229 isolates, 151 (66%) were (MDR-AB).
Susceptibility testing
Initial susceptibility testing was performed by either disk diffusion or broth microdilution using a commercially prepared panel (DADE Microscan, West Sacramento, CA). Isolates were considered to be MDR-AB if they were sensitive to 3 or less antibiotics. A notable characteristic was that all
Results
Age and sex demographics show a total of 86 men ranging in age from 22 to 85 years and 65 women ranging in age from 34 to 84 years. Sources of isolates were respiratory tract, 108 (72%); wounds, 32 (21%); blood, 6 (4%); and urine, 5 (3%). An epidemiologic review of MDR-AB isolates revealed that 20% of the ventilator-associated pneumonias (VAPs) reported in 2003 and 22% of the VAPs in 2004 were associated with MDR-AB. A low percentage of bloodstream infections (BSIs) and surgical site infections
Discussion
To control the spread of this organism in the ACH, a 3-fold team approach was initiated. This approach included (1) the Microbiology Department's rapid preliminary identification and notification to the Infection Control Department, (2) the placement of all new patients with positive isolates into contact precaution,4 and (3) the notification of attending physicians of the increased occurrence of MDR-AB.
The original infection control precautions—isolation of patients into private rooms, contact
Conclusion
MDR-AB, in agreement with the experience of others,6 is primarily a respiratory organism, with the majority of the isolates found to be colonizers rather than causing disease. The organism is very resistant to most antibiotics, but we do not believe it to be highly pathogenic. The incidence of new cases was as high as 15 isolates in June of 2003 and as low as 3 isolates in each of the months of March, April, and June of 2004. The LTAC appears to have been an ongoing reservoir for
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Supported by MERCK and Co., Inc. with a research grant.