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Althaqafi A, Yaseen M, Farahat F, Munshi A, Al-Hameed FM, Alshamrani MM, Alsaedi A, Al-Amri A, Chenia H, Essack SY. Evidence-Based Interventions to Reduce the Incidence of Common Multidrug-Resistant Gram-Negative Bacteria in an Adult Intensive Care Unit. Cureus 2023; 15:e39979. [PMID: 37416032 PMCID: PMC10321211 DOI: 10.7759/cureus.39979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
Background Multidrug-resistant Gram-negative bacteria (MDR-GNB) present a significant and escalating hazard to healthcare globally. Context-specific interventions have been implemented for the prevention and control of MDR-GNB in several healthcare facilities. The objective of this study was to implement and evaluate the effectiveness of evidence-based interventions in the incidence and dissemination of MDR-GNB. Methods This was a pre-and post-intervention study conducted in three phases at King Abdulaziz Medical City Jeddah, Saudi Arabia. During Phase-1, the data on each of the four MDR-GNB (Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli) were collected prospectively. Genomic fingerprinting was performed on isolates using enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) to determine clonality and establish a link between different strains within and between the hospital wards/units. In the second phase, targeted interventions were implemented in the adult intensive care unit (ICU) based on previously determined risk factors and included the education of healthcare workers on hand hygiene, disinfection of patients' surrounding, daily chlorhexidine baths, and disinfection rooms on discharge with hydrogen peroxide fogging after MDR-GNB patients were discharged. An antibiotic restriction protocol was simultaneously implemented as part of the hospital antibiotic stewardship program. In the third phase, the effectiveness of the interventions was evaluated by comparing the incidence rate and clonality (using ERIC-PCR genetic fingerprints) of MDR-GNB before and after the intervention. Results A significant reduction of MDR-GNB was observed in Phase-2 and Phase-3 compared with Phase-1. The mean incidence rate of MDR-GNB per 1000 patient days in Phase-1 (pre-intervention) was 11.08/1000, followed by 6.07 and 3.54/1000 in Phase-2 and Phase-3, respectively. A statistically significant reduction was observed in the incidence rate of MDR-GNB in the adult ICU (P=0.007), whereas no statistically significant decrease (P=0.419) was observed in areas other than the adult ICU. Two A. baumannii strains appear to be circulating within the ICU environment with reduced frequency in Phase-2 and Phase-3 compared to Phase-1. Conclusion There was a significant reduction in the incidence of MDR-GNB in the adult ICU due to the successful implementation of both infection control and stewardship interventions, albeit challenging to ascertain the relative contribution of each.
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Affiliation(s)
- Abdulhakeem Althaqafi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Infectious Diseases, King Abdullah International Medical Research Center, Jeddah, SAU
- Medicine/Infectious Diseases, King Abdulaziz Medical City, Jeddah, SAU
| | - Muhammad Yaseen
- Infection Prevention and Control, Bradford Teaching Hospitals National Health Service (NHS) Foundation Trust, Bradford, GBR
| | - Fayssal Farahat
- Public Health and Community Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Public Health and Community Medicine, Menoufia University, Shibin El Kom, SAU
- Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, SAU
| | - Adeeb Munshi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Infectious Diseases, King Abdullah International Medical Research Center, Jeddah, SAU
- Medicine/Infectious Diseases, King Abdulaziz Medical City, Jeddah, SAU
| | - Fahad M Al-Hameed
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Intensive Care Unit, King Abdullah International Medical Research Center, Jeddah, SAU
- Intensive Care Unit, King Abdulaziz Medical City, Jeddah, SAU
| | - Majid M Alshamrani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Infection Prevention and Control, King Abdullah International Medical Research Center, Riyadh, SAU
- Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, SAU
| | - Asim Alsaedi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Infection Prevention and Control, King Abdullah International Medical Research Center, Jeddah, SAU
- Infection Prevention and Control, King Abdulaziz Medical City, Jeddah, SAU
| | - Abdulfattah Al-Amri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Microbiology, King Abdullah International Medical Research Center, Jeddah, SAU
- Microbiology, King Abdulaziz Medical City, Jeddah, SAU
| | - Hafizah Chenia
- Microbiology, Discipline of Microbiology, School of Life Sciences, College of Agriculture, Engineering and Sciences, University of Kwazulu-Natal, Durban, ZAF
| | - Sabiha Y Essack
- Antimicrobial Research Unit, University of Kwazulu-Natal, Durban, ZAF
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Liu L, Liu B, Li W. Successful Incidences of Controlling Multidrug-Resistant, Extensively Drug-Resistant, and Nosocomial Infection Acinetobacter baumannii Using Antibiotic Stewardship, Infection Control Programs, and Environmental Cleaning at a Chinese University Hospital. Infect Drug Resist 2020; 13:2557-2570. [PMID: 32801793 PMCID: PMC7396956 DOI: 10.2147/idr.s260525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/05/2020] [Indexed: 01/22/2023] Open
Abstract
Objective We estimated the efficacy of antimicrobial stewardship (AMS), infection control programs (ICP), and environmental cleaning (ENC) for controlling the resistance of Acinetobacter baumannii (AB) and controlling the incidence of multidrug-resistant AB (MDRAB), extensively drug-resistant AB (XDRAB), and nosocomial infection AB in the ICU (NIAB-ICU) at a university hospital. Methods The intervention included 4-year AMS+ICP and 3-year AMS+ICP+ENC between January 2012 and December 2019. Results A total of 2636 AB isolates were collected totally, and 64.98% of AB isolates were MDR and 29.97% were XDR. Preintervention and postintervention incidences of MDRAB, XDRAB, and NIAB-ICU by AMS+ICP measures ranged from 84.96% to 71.98%, 41.96% to 33.13%, and 45.6% to 38%, respectively. However, all of them were not statistically changed (P=0.085, 0.072, 0.061, separately). The preintervention and postintervention incidences of MDRAB, XDRAB, and NIAB-ICU by AMS+ICP+ENC measures ranged from 71.98% to 36.55%, 33.13% to 19.88%, and 38% to 22.5%, respectively. Statistically significant declines were observed (P=0.016, 0.041, 0.032, separately). The defined daily doses (DDD) per 1000 patient-days (PD) decreased from 45±3.3 to 30.81±1.5 per 1000 PD across from 2012 to 2019, and a statistical decline was seen (P=0.01). Concurrently, the alcohol-based hand gel (ABHG) consumption per 1000 PD increased from 0.6±0.05 L to 12.5±2.3 L per 1000 PD, and a statistical increase was observed (P=0.0001). A statistically positive correlation was revealed between the DDD and incidence of MDRAB, XDRAB, and NIAB-ICU (r=0.905 and p=0.002; r=0.939 and p=0.001; r=0.956 and p=0.0002; respectively). Simultaneously, a statistically negative correlation was showed between the ABHG and incidence of MDRAB, XDRAB, and NIAB-ICU (r=-0.858 and p=0.006; r=-0.888 and p=0.003; r=-0.882 and p=0.004, separately). Conclusion The AMS, ICP, and ENC may be one of the most effective and best measures to address the increasing incidence of MDRAB, XDRAB, and NIAB-ICU currently.
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Affiliation(s)
- Lei Liu
- Heilongjiang Key Laboratory for Zoonosis, College of Veterinary Medicine, Northeast Agricultural University, Harbin, People's Republic of China.,Department of Respiratory Medicine, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Bin Liu
- Department of Respiratory Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Wei Li
- Heilongjiang Key Laboratory for Zoonosis, College of Veterinary Medicine, Northeast Agricultural University, Harbin, People's Republic of China
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