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KMID : 1141420190240020081
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Korean Journal of Healthcare-associated Infection Control Prevention
2019 Volume.24 No. 2 p.81 ~ p.87
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Colonization Prevalence and Risk Factor Analysis of CarbapenemResistant Acinetobacter baumannii in an Intensive Care Unit without Outbreaks
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Kim Young-Ah
Park Yoon-Soo
Lee Sang-Sun
Son Young-Jun
Yeon Jeong-Hwa
Seo Young-Hee
Lee Kyung-Won
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Abstract
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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, blaOXA51-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.
Results: Among the 291 patients, the colonization rate of CRAB at ICU admission was 5.2%. The carbapenem resistance mechanism of CRAB colonizers is mostly due to OXA-23-like enzyme production. A risk factor was found to be previous admission to long-term care facilities.
Conclusion: To perform ASC for detecting CRAB in ICU-admitted patients, the colonization rate of CRAB should be considered. Patients with a history of admission to a long-term care facility should be prioritized.
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KEYWORD
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Acinetobacter baumannii, Carbapenem resistance, Colonization, Infection control
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