title: Application of Bacteriophage-containing Aerosol against Nosocomial Transmission of Carbapenem-Resistant Acinetobacter baumannii in an Intensive Care Unit.
abstract: BACKGROUND
  Carbapenem-resistant Acinetobacter baumannii (CRAB) is associated with nosocomial infections worldwide. Here, we used phage as a potential agent to evaluate the efficacy of daily cleaning practices combined with a bacteriophage-containing aerosol against CRAB.
  
  
  METHODS
  A two-phase prospective intervention study was performed at a 945-bed public teaching hospital. From March to December 2013, we performed terminal cleaning using standard procedures plus an aerosol with active bacteriophage in the intensive care units to evaluate the impact on nosocomial incidence density, carbapenem-resistance rates and antimicrobial drug consumption amounts. Patients with culture proven CRAB infection were transferred to the isolation room when the phage aerosol cleaning had been completed.
  
  
  RESULTS
  A total of 264 new acquisitions of CRAB were identified in the intensive care units (191 in the pre-intervention period and 73 in the intervention period). The rates of new acquisitions of CRAB in the intensive care units decreased from 8.57 per 1000 patient-days in the pre-intervention period to 5.11 per 1000 patient-days in the intervention period (p = 0.0029). The mean percentage of resistant isolates CRAB decreased from 87.76% to 46.07% in the intensive care units (p = 0.001). All of the antimicrobials showed a significant reduction in consumption except imipenem.
  
  
  CONCLUSIONS
  The bacteriophage was successful in decreasing the rates of infection caused by CRAB across intensive care units in a large teaching hospital.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: Yu-Huai
authors.initials: YH
authors.lastname: Ho
authors.affiliation: Department and Graduate Institute of Public Health, Tzu Chi University, Hualien, Taiwan.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Tseng
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: Lih-Shinn
authors.initials: LS
authors.lastname: Wang
authors.affiliation: Medical Intensive Care Unit, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Chen
authors.affiliation: Department of Surgical Critical Care Unit, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: Guan-Jin
authors.initials: GJ
authors.lastname: Ho
authors.affiliation: Department of Laboratory Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
authors.forename: Teng-Yi
authors.initials: TY
authors.lastname: Lin
authors.affiliation: Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
authors.forename: Ling-Yi
authors.initials: LY
authors.lastname: Wang
authors.affiliation: Institute of Medical Sciences, Department of Laboratory Diagnostic, College of Medicine, Tzu Chi University, Hualien, Taiwan.|Department of Laboratory Medicine, Clinical Pathology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
authors.forename: Li-Kuang
authors.initials: LK
authors.lastname: Chen
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification*; D000336:Aerosols; D001435:Bacteriophages / Q000502:physiology*; D015780:Carbapenems / Q000008:administration & dosage* / Q000494:pharmacology; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D011446:Prospective Studies
chemical_list: D000336:Aerosols; D015780:Carbapenems