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

Conclusions

Our prudent use of antimicrobial drugs did not increase mortality rates and had a dramatic effect on antimicrobial consumption and MDR A. baumanii isolate density. A longer study period and larger sample likely would reveal additional effects on XDR infections and outcomes. Many factors could have affected the study results, including patient referrals and seasonality. However, the microbiological findings strongly point to high rates of carbapenem consumption as a sustaining factor in survival of XDR A. baumanii ST2 in our facility. By reducing carbapenem consumption, we broke a vicious cycle.

In the era where clinicians must manage severely ill, MDR-colonized patients, relying on existing guidelines is not enough. A creative, multidisciplinary approach with knowledge of local epidemiology is key to controlling MDR and XDR infections. Investing time in accurate diagnosis and implementing targeted carbapenem-sparing strategies for initial treatment is only possible through trusted collaboration between ID and ICU physicians. The dedication of the ASP and microbiology departments at this facility is an example of a successful active surveillance program for antimicrobial drug consumption and resistance profiles, especially when developing standards of care tailored to meet an institution's needs.

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