Control and Elimination of Extensively Drug-Resistant Acinetobacter Baumanii in an Intensive Care Unit

Amanda Chamieh; Tania Dagher Nawfal; Tala Ballouz; Claude Afif; George Juvelekian; Sani Hlais; Jean-Marc Rolain; Eid Azar

Disclosures

Emerging Infectious Diseases. 2019;25(10):1928-1931. 

In This Article

Abstract and Introduction

Abstract

We decreased antimicrobial drug consumption in an intensive care unit in Lebanon by changing to colistin monotherapy for extensively drug-resistant Acinetobacter baumanii infections. We saw a 78% decrease of A. baumanii in sputum and near-elimination of bla oxa-23-carrying sequence type 2 clone over the 1-year study. Non–A. baumanii multidrug-resistant infections remained stable.

Introduction

The antimicrobial stewardship program (ASP) at Saint Georges Hospital University Medical Center (SGHUMC), a 400-bed tertiary-care center in Beirut, Lebanon, requires an infectious disease (ID) specialist to preauthorize use of restricted broad-spectrum antimicrobial drugs. The ASP regularly monitors the rate of nosocomial infections and the total hospital antimicrobial drug consumption. In the first quarter of 2015, the incidence of extensively drug-resistant (XDR) Acinetobacter baumanii bloodstream infections reached its highest level, 0.47/1,000 patient-days.[1] Since 2012, the monthly carbapenem consumption increased steadily, reaching 130 defined daily doses (DDD)/1,000 patient-days in 2015, an absolute increase of 30 DDD/1,000 patient-days during that time. Severely ill patients with predisposing conditions are more likely to develop difficult-to-treat A. baumanii infections. Despite the existing controversy, this patient population routinely is treated with a carbapenem/colistin combination.[2–8]

We evaluated 100 nonduplicate XDR A. baumanii isolates at SGHUMC and found no synergy between colistin and carbapenem by the checkerboard technique.[9] Consequently, SGHUMC withdrew combination therapy for XDR A. baumanii infections. Our aim was to evaluate the effect of a carbapenem-sparing regimen on ICU antimicrobial consumption, clinical outcome, and microbiological flora.

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