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Preventing strategy of multidrug-resistant Acinetobacter baumanii susceptible only to colistin in cardiac surgical intensive care units

Department of Surgical Intensive Care Unit, Onassis Cardiac Surgery Center, 356 Sygrou Avenue, 17674 Athens, Greece

Received 5 November 2007; received in revised form 5 February 2008; accepted 6 February 2008.

^_* Corresponding author. Address: 29, Irodoutou Street, 15122, Maroussi, Athens, Greece. Tel.: +30 210 8063790; fax: +30 210 9493333. (Email: dr_kamast{at}yahoo.gr).

Objective: The study aimed to determine the incidence and mortality of multidrug-resistant Acinetobacter baumannii in cardiac surgery, to elucidate the effectiveness of colistin treatment and to identify if the additional measures to the recommended procedures were able to control the dissemination of the pathogen. Methods: A prospective observational cohort was conducted among cardiac surgical patients from 1 September 2005 to 31 December 2006. We reviewed the prophylactic measures of the surgical intensive care unit and implemented a two scale multiple program. Scale I included classical infection control measures, while Scale II referred to the geographic isolation of multidrug-resistant Acinetobacter baumannii patients and environmental intense surveillance. Results: Among 151 out of 1935 infected patients 20 were colonized and infected by strains of multidrug-resistant A. baumannii susceptible only to colistin. Seventeen patients presented respiratory tract infection, one patient suffered deep surgical site infection and two patients catheter related infection. Transmission of the pathogen occurred via two patients transferred from two other institutions. They were all treated with colistin. Cure or clinical improvement was observed only in four patients (20%). Scale I measures were implemented for the whole 16-month period while scale II for two separate periods of 3 weeks. Environmental specimens (n > 350) proved negative. Conclusions: The increasing prevalence of multidrug-resistant A. baumannii in surgical intensive care unit patients creates demand on strict screening and contact precautions. Following this infection control strategy we were able to achieve intermittent eradication of the pathogen during a 16-month period with continuous function of the intensive care unit. Despite the significant in vitro activity of colistin against multidrug-resistant Acinetobacter baumannii the results were discouraging.

Key Words: Acinetobacter baumannii • Cardiac surgery • Preventing strategy

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