title: Controlling endemic multidrug-resistant Acinetobacter baumannii in Intensive Care Units using antimicrobial stewardship and infection control.
abstract: OBJECTIVE
  Nosocomial infections caused by multidrug-resistant (MDR) Acinetobacter baumannii have become public-health problem. However, few studies have evaluated the control of endemic MDR A. baumannii in Intensive Care Units (ICUs). Therefore, we investigated the effectiveness of antimicrobial stewardship and comprehensive intensified infection control measures for controlling endemic MDR A. baumannii in ICUs at a tertiary care center.
  
  
  METHODS
  Carbapenem use was strictly restricted through antimicrobial stewardship. Environmental cleaning and disinfection was performed at least 3 times per day in addition to basic infection control measures. Isolation using plastic curtains and contact precautions were applied to patients who were colonized or infected with MDR A. baumannii. The outcome was measured as the incidence density rate of hospital-onset MDR A. baumannii among patients in the ICUs.
  
  
  RESULTS
  The incidence density rate of hospital-onset MDR A. baumannii decreased from 22.82 cases per 1,000 patient-days to 2.68 cases per 1,000 patient-days after the interventions were implemented (odds ratio, 0.12; 95% confidence interval, 0.03 to 0.4; p < 0.001). The mean monthly use of carbapenems also decreased from 134.99 ± 82.26 defined daily doses per 1,000 patient-days to 94.85 ± 50.98 defined daily doses per 1,000 patient-days (p = 0.016).
  
  
  CONCLUSIONS
  Concomitant implementation of strict antimicrobial stewardship and comprehensive infection control measures effectively controlled endemic MDR A. baumannii in our ICUs within 1 year.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Shinhye
authors.initials: S
authors.lastname: Cheon
authors.affiliation: Department of Nursing, Daejeon Institute Science and Technology, Daejeon, Korea.
authors.forename: Mi-Ja
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Infection Control, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Seon-Jin
authors.initials: SJ
authors.lastname: Yun
authors.affiliation: Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Moon
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.|Department of Infection Control, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Yeon-Sook
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000472:pathogenicity; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015780:Carbapenems / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D004203:Disinfection; D024901:Drug Resistance, Multiple, Bacterial; D019353:Endemic Diseases; D006235:Hand Disinfection; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D008826:Microbial Sensitivity Tests; D016017:Odds Ratio; D010356:Patient Isolation; D015397:Program Evaluation; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Acinetobacter baumannii; Antimicrobial stewardship; Infection control