title: Outbreak of resistant Acinetobacter baumannii- measures and proposal for prevention and control.
abstract: Acinetobacter baumannii colonization and infection, frequent in Intensive Care Unit (ICU) patients, is commonly associated with high morbimortality. Several outbreaks due to multidrug-resistant (MDR) A. baumanii have been reported but few of them in Brazil. This study aimed to identify risk factors associated with colonization and infection by MDR and carbapenem-resistant A. baumannii strains isolated from patients admitted to the adult ICU at HC/UFMG. A case-control study was performed from January 2007 to June 2008. Cases were defined as patients colonized or infected by MDR/carbapenem-resistant A. baumannii, and controls were patients without MDR/carbapenem-resistant A. baumannii isolation, in a 1:2 proportion. For statistical analysis, due to changes in infection control guidelines, infection criteria and the notification process, this study was divided into two periods. During the first period analyzed, from January to December 2007, colonization or infection by MDR/carbapenem-resistant A. baumannii was associated with prior infection, invasive device utilization, prior carbapenem use and clinical severity. In the multivariate analysis, prior infection and mechanical ventilation proved to be statistically significant risk factors. Carbapenem use showed a tendency towards a statistical association. During the second study period, from January to June 2008, variables with a significant association with MDR/carbapenem-resistant A. baumannii colonization/infection were catheter utilization, carbapenem and third-generation cephalosporin use, hepatic transplantation, and clinical severity. In the multivariate analysis, only CVC use showed a statistical difference. Carbapenem and third-generation cephalosporin use displayed a tendency to be risk factors. Risk factors must be focused on infection control and prevention measures considering A. baumanni dissemination.
authors.affiliation: Comissão de Controle de Infecção Hospitalar, Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil. rmcromanelli@medicina.ufmg.br <rmcromanelli@medicina.ufmg.br>
authors.forename: Roberta Maia de Castro
authors.initials: RM
authors.lastname: Romanelli
authors.forename: Lenize Adriana de
authors.initials: LA
authors.lastname: Jesus
authors.forename: Wanessa Trindade
authors.initials: WT
authors.lastname: Clemente
authors.forename: Stella Sala Soares
authors.initials: SS
authors.lastname: Lima
authors.forename: Edna Maria
authors.initials: EM
authors.lastname: Rezende
authors.forename: Rosane Luiza
authors.initials: RL
authors.lastname: Coutinho
authors.forename: Ricardo Luiz Fontes
authors.initials: RL
authors.lastname: Moreira
authors.forename: Francelli Aparecida Cordeiro
authors.initials: FA
authors.lastname: Neves
authors.forename: Nelma de Jesus
authors.initials: Nde J
authors.lastname: Brás
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000517:prevention & control; D040981:Acinetobacter baumannii / Q000302:isolation & purification*; D000328:Adult; D015780:Carbapenems; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D012307:Risk Factors; D012720:Severity of Illness Index; D018440:beta-Lactam Resistance
chemical_list: D015780:Carbapenems