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Spread of multidrug-resistant Acinetobacter baumannii in intubated patients

Abstract number: P793

Alp E., Yerer M., Kocagöz S., Metan G., Esel D., Gurol Y., Doganay M.

Objectives:Acinetobacter baumannii constitutes one of the most common cause of ventilator associated pneumonia in intensive care units. The colonised patients are important source for environmental contamination and patient-to-patient spread of microorganism. The major mode of transmission from patient-to-patient and environment-to-patient is contaminated hands of healthcare workers. The aim of this study was to determine the risk factors for the colonisation of respiratory tract and infection with A. baumannii in medical ICU (MICU) and examine the genetic relatedness of the strains to show the spread of isolates.

Methods: This study was conducted prospectively between December 1, 2004 and January 31, 2006 in MICU. Patients (>16 years) admitted to the MICU and mechanical ventilated and/or intubated were enrolled in the study. Endotracheal aspirate of these patients were screened for A. baumannii at the beginning of intubation (in the first 48 hours), at the end of first week and at the time of withdrawal of endotracheal tube. Patients intubated shorter than 48 hours were not included into the study and data of A. baumannii colonised or infected patients at ICU admission were not evaluated for the risk factors. Strains isolated from colonised and infected patients were evaluated for genetic relatedness. Genotyping analysis was performed by pulsed-field gel electrophoresis (PFGE)

Results: Ninety-eight patients were evaluated for A. baumannii colonisation during or at the end of their entubation and 44 (45%) of these patients were colonised with A. baumannii. The mean time for A. baumannii acquisition was 7.46±3.74 days (range 2 to 16 days). The length of entubation (OR:1.032, p: 0.014) and diabetes mellitus (OR:4.140, p:0.008) were found to be the major risk factors for the colonisation of respiratory tract with A. baumannii. During the study period, A. baumannii infection developed in 35 (80%) of 44 colonised patients. The important risk factors for infection were A. baumannii colonisation (OR:3.962, p:0.006) and tracheostomy (OR:4.857, p:0.001). Genotyping analysis was performed for 59 isolates. Overall, three clones (clone A, B, C) were determined from patients, whereas 88% belonged to clone A (52 isolates), 7% clone B (four isolates) and 5% clone C (three isolates).

Conclusion: This study showed the spread of A. baumannii in intubated patients in a ICU with inadequate infrastructure.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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