title: [Monitoring and control of pan-drug resistant Acinetobacter baumannii colonization and infection in a medical intensive care unit].
abstract: OBJECTIVE
  To describe the monitoring and control of pan-drug resistant Acinetobacter baumannii (XDRABA) colonization and infection in a medical intensive care unit (ICU), and to summarize the effective measures of surveillance of nosocomial infection and control.
  
  
  METHODS
  Nonsurgical patients admitted to medical ICU of Peking University People's Hospital from September 2009 to April 2013 with length of ICU stay over 48 hours were surveyed. Number of cases of colonization and infection of XDRABA per month was recorded, and the clinical features of patients with XDRABA colonization and infection were observed. The control of XDRABA colonization and infection was divided into three stages: (1) Outbreak stage, from September 2009 to August 2010, the infection control measures included stringent hand hygiene and surface disinfection, use of disposable ventilator tubes and improvement in antibiotics use. (2) Environmental control stage, from September 2010 to April 2012, the infection control measures consisted of on-the-spot investigation, isolation of patients with XDRABA colonization and infection, tubes terminal environment disinfection. (3) Microbial screening stage, from May 2012 to April 2013, throat, nose and axillary swabs were obtained when the patients admitted.
  
  
  RESULTS
  From 2009 September to 2013 April there was a total of 193 patients colonized or infected with XDRABA, and 64 patients died (mortality rate was 33.2%), and 133 (68.9%) patients were on mechanical ventilation. Patients with XDRABA colonization and infection had severer illness [acute physiology and chronic health evaluation II (APACHEII) score 20.3±6.7], longer ICU stay [(34.6±13.8) days]. In outbreak stage, number of cases with XDRABA colonization and infection was 5-9 per month. In environmental control stage, case number of XDRABA colonization and infection was 3-6 per month. In microbial screening stage, case number of XDRABA colonization and infection, which were already present, was 2-4 per month, and they were mainly admitted from emergency department (59.5%). The number of cases of ICU acquired XDRABA colonization and infection decreased from 2-3 to 0-1 per month.
  
  
  CONCLUSIONS
  To control the colonization and infection of XDRABA, monitoring of microorganism, hand hygiene, isolation of patients with XDRABA colonization and infection, and stringent environment disinfection were very necessary.
authors.affiliation: Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China. Corresponding author: An Youzhong, Email: bjicu@163.com.
authors.forename: Huiying
authors.initials: H
authors.lastname: Zhao
authors.forename: Chongge
authors.initials: C
authors.lastname: Yang
authors.forename: Yang
authors.initials: Y
authors.lastname: Guo
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.forename: Yinghong
authors.initials: Y
authors.lastname: Wu
authors.forename: Youzhong
authors.initials: Y
authors.lastname: An
mesh_terms: D000151:Acinetobacter Infections / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000187:drug effects*; D003428:Cross Infection / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D012189:Retrospective Studies