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Volume 25, Number 10—October 2019
Dispatch

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

Amanda Chamieh1, Tania Dagher Nawfal1, Tala Ballouz1, Claude Afif, George Juvelekian, Sani Hlais, Jean-Marc Rolain, and Eid AzarComments to Author 
Author affiliations: University of Balamand, Beirut, Lebanon (A. Chamieh, T. Ballouz, C. Afif, G. Juvelekian, E. Azar); Aix-Marseille University, Marseille, France (T.D. Nawfal, J.-M. Rolain); Saint Joseph University and American University of Beirut, Beirut (S. Hlais)

Main Article

Table 1

Patient demographics, VAP incidence, treatment courses, and antimicrobial drug consumption in study of carbapenem-sparing regimen for XDR Acinetobacter baumannii in an ICU, Beirut, Lebanon*

Characteristics Period 1† Period 2‡ p value
Patient data
No. patients 213 324 NA
Sex
F 79 144
M 134 180
Mean age 69 68
Mean length of hospital stay, d 6.8 6
Days in ICU
 1,128
 1,804
Type of admission
Medical 163 253 NA
Surgical 50 71
Admitted from home or ED 73 114
Transferred from ward 79 141
Transferred from other hospital 10 16
Postoperative
 51
 57
Intubation
At admission 64 85
After admission
 14
 16
Outcome
A. baumanii VAP incidence, % 15 3.7 0.007
Discharged 170 259
Deceased 43 64
Total AB VAP events 32 12
Deceased during VAP
 17
 4
ICU mean mortality rate/month, % 20.4 19.3 0.168
AB VAP case fatality ratio, %
 7.9
 1.2
 0.006
No. XDR A. baumanii VAP courses received
Colistin and carbapenem 17 2
Colistin and tigecycline 6 2
Colistin monotherapy 6 6
Tigecycline
 3
 2
Carbapenem consumption, DDD§
Group 1 333 320 0.465
Group 2 455 224 0.042
Group 3 541 223 <0.005
Group 4 165 145 0.808
Group 5
Colistin 20 9 <0.019
Tigecycline
 84
 62
 0.570
Total restricted antimicrobial drugs, DDD 1,265 663 <0.005

*Bold indicates statistical significance. DDD, defined daily doses; ED, emergency department, ESBL, extended-spectrum β-lactamase; ICU, intensive care unit; NA, not applicable; VAP, ventilator-associated pneumonia; XDR, extensively drug-resistant.
†During February 1, 2016–June 30, 2016, ICU patients received colistin/carbapenem therapy for A. baumannii infections.
‡During July 1, 2016–January 31, 2017, ICU implemented carbapenem-sparing regimen for A. baumannii infections.
§Group 1, antimicrobial drugs that do not require infectious disease specialist preapproval, such as third-generation cephalosporins, amoxicillin/clavulanic acid, and quinolones; group 2, oral vancomycin and metronidazole used for Clostridioides difficile therapy; group 3, imipenem and meropenem; group 4, broad-spectrum carbapenem-sparing regimens, including piperacillin/tazobactam, cefepime, ceftazidime, amikacin; and group 5, the XDR A. baumanii–active antimicrobial drugs colistin and tigecycline.

Main Article

1These authors contributed equally to this article.

Page created: September 17, 2019
Page updated: September 17, 2019
Page reviewed: September 17, 2019
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