Incidence, risk factors, and outcome of multidrug-resistant Acinetobacter baumannii acquisition during an outbreak in a burns unit.
J Hosp Infect
; 97(3): 226-233, 2017 Nov.
Article
em En
| MEDLINE
| ID: mdl-28751010
ABSTRACT
BACKGROUND:
Multidrug-resistant Acinetobacter baumannii (MR-AB) can cause outbreaks in a burns unit.AIM:
To study the incidence, risk factors and outcome of MR-AB colonization during an outbreak.METHODS:
A prospective study was conducted from April to November 2014 in a burns unit in Paris. Weekly surveillance cultures of patients and their environment were performed. MR-AB acquisition, discharge, or death without MR-AB colonization were considered as competing events. To identify risk factors for colonization, baseline characteristics and time-dependent variables were investigated in univariate and multivariate analyses using Cox models. MR-AB strains were genotypically compared using multi-locus sequence typing.FINDINGS:
Eighty-six patients were admitted in the burns unit during the study period. Among 77 patients without MR-AB colonization at admission, 25 (32%) acquired MR-AB with a cumulative incidence of 30% at 28 days (95% CI 20-40). Median time to MR-AB acquisition was 13 days (range 5-34). In multivariate analysis, risk factors for MR-AB acquisition were ≥2 skin graft procedures performed [hazard ratio (HR) 2.97; 95% confidence interval (CI) 1.10-8.00; P = 0.032] and antibiotic therapy during hospitalization (HR 4.42; 95% CI 1.19-16.4; P = 0.026). A major sequence type of MR-AB (ST2) was found in 94% and 92% of patients and environmental strains, respectively, with all strains harbouring the blaOXA-23 gene. MR-AB colonization increased length of hospitalization (HR 0.32; 95% CI 0.17-0.58; P = 0.0002) by a median of 12 days.CONCLUSION:
A high incidence of MR-AB acquisition was seen during this outbreak with most strains from patients and their environment belonging to single sequence type. MR-AB colonization was associated with more skin graft procedures, antibiotic use, and prolonged hospitalization.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Queimaduras
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Infecções por Acinetobacter
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Infecção Hospitalar
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Surtos de Doenças
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Farmacorresistência Bacteriana Múltipla
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Acinetobacter baumannii
Tipo de estudo:
Etiology_studies
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Incidence_studies
/
Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Aged
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Female
/
Humans
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Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article