Nosocomial colonisation and infection of ICU patients caused by persistent and multiresistant clones of Acinetobacter baumannii
Abstract number: p1802
Vagiakou E., Karabinis A., Mylona-Petropoulou D., Paramythiotou E., Tassios P., Tzouvelekis L., Mergioti C., Diamantopoulou G., Legakis N., Malamou-Lada H.
To evaluate the nosocomial colonization and infection of ICU patients caused by
A. baumannii (Ab) and to investigate the persistent clones over a 2 year period (May 2002-April 2004).
We performed surveillance of patients, healthcare stuff and ICU environment and we registered the infections of Ab during 3 periods of 21 days each one. The interval between 1st2nd period was 6 months and 2nd3rd period was 1 year. Rectal, oropharyngeal swabs tracheal aspirates from patients, handswabs from stuff and samples from environment were taken weekly. The identification of Ab was performed using Vitek II system the susceptibility was tested by Kirby-Bauer and MIC methods and the <<DNA fingerprints>>obtained by pulsed field gel electrophoresis (PFGE).
During the 1st 2nd and 3rd period, 19 patients (14 men, 5 women), 13 patients (7 men, 6 women) and 12 patients (8 men, 4 women) were hospitalized in ICU respectively. Ab was isolated in 74 from 250 samples (29.6%) at the 1st period, 59 from 336 (17.5%) at the 2nd and 62 from 260 (24%) at the 3rd period. Totally Ab was isolated in 195 from 846 specimens (23%) At the 1st 2nd and 3rd period among the patients carrying Ab, 7/14 (50%), 7/10 (70%) and 5/8 (62%) were infected respectively. The infections observed during the study period were: sepsis (8), urinary tract infection (1), pneumonia (11), meningitis (1), thrombophlebitis (2). All the isolated Ab strains were multiresistant to antimicrobial agents. Molecular analysis of 169 isolated strains by PFGE distinguished the following types: A (64, subtypes A1A7), B (10) at the 1st period A(6), C(7), D(22), E(2), F(1), G(1), H(2), I(1). J(1) at the 2nd period A(25), B (16), D(1), H(3), K(2). L(5) at the 3rd period. Infections were caused mainly by A and D types while the same types were isolated from the environment and the hands of the ICU stuff.
There was a high rate of colonization and infection of ICU patients by multiresistant clones of Ab. The persistence of clone A of A. baumannii and the appearance of B type at the 3rd period after its disappearance at the 2nd period despite the application hygiene measures, indicates the need for more strict reinforced infection control in ICU. The transmission via the hands of stuff to patients has become the most important contributor factor in patient colonization and/or infection.
|Session name:||XXIst ISTH Congress|
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