title: Active surveillance for carbapenem-resistant Acinetobacter baumannii in a medical intensive care unit: Can it predict and reduce subsequent infections and the use of colistin?
abstract: BACKGROUND
  Infection caused by carbapenem-resistant Acinetobacter baumannii (CRAB) has become a major problem in intensive care units (ICUs), with high incidence and mortality. This prospective study investigated the diagnostic value and influence of active surveillance, followed by isolation and enhanced contact precaution (IECP), on the subsequent CRAB infection and colistin use.
  
  
  METHODS
  The study prospectively enrolled 1,115 patients who were admitted to the medical ICU of Chonnam National University Hwasun Hospital between April 2011 and November 2014. Active surveillance cultures were obtained from the throat or trachea, skin, and urine. IECP was performed beginning April 2013.
  
  
  RESULTS
  Active surveillance detected CRAB in 168 (15%) patients and CRAB infection developed in 70 (6%) patients. Endotracheal tube was independently associated with both CRAB colonization and infection, whereas IECP was inversely associated with both CRAB colonization and infection in multivariate analysis (all P values <.001). The sensitivity, specificity, and positive and negative predictive values of active surveillance for subsequent CRAB infection were 84%, 90%, 47%, and 98%, respectively. The rate of CRAB acquisition, CRAB infection, and the use of colistin were significantly lower during the IECP period compared with the control period (6.5 vs 34.1, 2.6 vs 14.7, and 19.9 vs 65.5 per 1,000 patient-days, respectively; all P <.001).
  
  
  CONCLUSIONS
  Active surveillance has good specificity and negative predictive value for subsequent CRAB infection. Active surveillance followed by IECP was inversely associated with the acquisition of CRAB and subsequent CRAB infection, and was associated with a reduction in colistin use in ICU patients.
authors.affiliation: Departments of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, South Korea.
authors.forename: Joon Hwan
authors.initials: JH
authors.lastname: An
authors.affiliation: Infection Control Office, Hwasun Chonnam Nationality University Hospital, Hwasun, South Korea.
authors.forename: Yu-Hyoung
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Infection Control Office, Hwasun Chonnam Nationality University Hospital, Hwasun, South Korea.
authors.forename: Jeong-Eun
authors.initials: JE
authors.lastname: Moon
authors.affiliation: Infection Control Office, Hwasun Chonnam Nationality University Hospital, Hwasun, South Korea.
authors.forename: Jong Hae
authors.initials: JH
authors.lastname: Jeong
authors.affiliation: Department of Laboratory Medicine, Chonnam National University Medical School, Gwang-ju, South Korea.
authors.forename: Soo-Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Departments of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, South Korea.
authors.forename: Seung-Ji
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: Departments of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, South Korea.
authors.forename: Kyung-Hwa
authors.initials: KH
authors.lastname: Park
authors.affiliation: Departments of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, South Korea.
authors.forename: Sook-In
authors.initials: SI
authors.lastname: Jung
authors.affiliation: Departments of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, South Korea; Infection Control Office, Hwasun Chonnam Nationality University Hospital, Hwasun, South Korea. Electronic address: haroc153@naver.com.
authors.forename: Hee-Chang
authors.initials: HC
authors.lastname: Jang
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000187:drug effects*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015780:Carbapenems / Q000494:pharmacology; D003091:Colistin / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010356:Patient Isolation; D011159:Population Surveillance / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D003091:Colistin
keywords: Incidence; Isolation; Precaution