Colonization Prevalence and Risk Factor Analysis of Carbapenem-Resistant Acinetobacter baumannii in an Intensive Care Unit without Outbreaks

Young Ah Kim, Yoon Soo Park, Sang Sun Lee, Young Jun Son, Jeong Hwa Yeon, Young Hee Seo, Kyungwon Lee
2019 Korean Journal of Healthcare-Associated Infection Control and Prevention  
Introduction 국내 Acinetobacter baumannii의 carbapenem에 대 한 내성율은 매우 높으며, 질병관리본부의 자료에 의하면 2015년 분리주의 85%가 imipenem에 내성으로 보고되 어 있다[1]. A. baumannii는 주로 의료관련감염(health-의료관련감염관리 : 제24권 제2호 2019 Korean J healthc assoc Infect Control Prev 2019;24(2):81-87 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
more » ... ed 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 (bla OXA-23-like , bla OXA-24-like , bla OXA-51-like , bla OXA-58-like , ISAba1-bla OXA-23-like , and ISAba1-bla OXA-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.
doi:10.14192/kjicp.2019.24.2.81 fatcat:sra7j3aocvcvnkejgr6ncgk5hi