Abstract:

Objective  To evaluate the effect of de-escalation prevention and control strategy on controlling the cross-infection of multi-drug resistant Acinetobacter baumannii (MDRAB) in surgery intensive care unit (SICU) and analyze characteristics of strains and clinical features of colonization and infection. Methods  The active bacterial surveillance and the de-escalation prevention and control strategy were carried out for all patients admitted in SICU of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from August 2013 to July 2014. Effects of prevention and control, characteristics of strains, and clinical parameters were analyzed. Results  A total of 49 strains of MDRAB with high antibiotic resistance were isolated and 32 (65.3%) of them were strains of colonization and 17 (34.7%) of them were strains of infection. Both overall detection rate and SICU acquired rate of MDRAB significantly decreased (P<0.001). The administration rate of carbapenem before admission and incidence of high APACHEⅡ score, shock, acute respiratory dysfunction, acute kidney injury and mechanical ventilation of patients with MDRAB colonization/infection were significantly higher than those of patients without MDRAB colonization/infection (P<0.05).  However, the differences of clinical features between patients with MDRAB colonization and patients with MDRAB infection were not statistically significant (P>0.05). Conclusion  It is difficult to analyze and predict the MDRAB infection based on clinical high risk factors. However, the spread of drug resistant bacteria can be efficiently controlled and cross-infection rate of MDRAB in SICU can be decreased by classification of high risk factors and application of de-escalation prevention and control strategy.

Key words: multi-drug-resistant, Acinetobacter baumannii, prevention and control, colonization, infection