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.
Collapse