Résumé
BACKGROUND: A sustained outbreak of multi-resistant Acinetobacter baumannii has been noticed in intensive care unit (ICU) of a newly opened hospital. METHODS: We retrospectively studied 72 patients in the ICU whose specimen grew A. baumannii from March to December 1995. To identify risk factors for infection, a case control study was conducted. Comparing clinical characteristics of 19 infected patients with those of 53 colonized cases. Environmental culture was performed in January 1996 to identify the source of infection. We analyzed antibiotic susceptibility of the isolates, and ribotyping was performed with 52 isolates. RESULTS: Nineteen out of 72 patients developed disease: primary sepsis 2, catheter related infection 2, catheter related infection and pneumonia 2, wound infection 5, wound infection and sepsis 2, pneumonia 6. On comparison of clinical characteristics between the infected and colonized groups, central venous catheterization was a significant risk factor for development of disease by A. baumannii (P<0.05) and duration of lCU stay was a factor independently associated with A. baumannii infection by logistic regression analysis. An epidemiologic investigation failed to identify the source of infection, but we found 2 of 3 sinks in lCU were heavily contaminated by the organism. Antibiogram of the isolates showed a multi-drug resistance including amikacin, which was found to increase gradually during the course of the outbreak. Ribotyping showed 3 major subtypes: 2A (18 isolates) 2B (16) 2B'(13) and other types (5). CONCLUSION: The findings from this study support the reports from many parts of the world that A. baumannii plays an increasingly important role as one of the major nosocomial pathogens.
Sujets)
Humains , Acinetobacter baumannii , Amikacine , Études cas-témoins , Cathétérisme veineux central , Cathéters , Voies veineuses centrales , Côlon , Multirésistance aux médicaments , Unités de soins intensifs , Soins de réanimation , Modèles logistiques , Tests de sensibilité microbienne , Pneumopathie infectieuse , Études rétrospectives , Ribotypage , Facteurs de risque , Sepsie , Infection de plaieRésumé
BACKGROUND: A sustained outbreak of multi-resistant Acinetobacter baumannii has been noticed in intensive care unit (ICU) of a newly opened hospital. METHODS: We retrospectively studied 72 patients in the ICU whose specimen grew A. baumannii from March to December 1995. To identify risk factors for infection, a case control study was conducted. Comparing clinical characteristics of 19 infected patients with those of 53 colonized cases. Environmental culture was performed in January 1996 to identify the source of infection. We analyzed antibiotic susceptibility of the isolates, and ribotyping was performed with 52 isolates. RESULTS: Nineteen out of 72 patients developed disease: primary sepsis 2, catheter related infection 2, catheter related infection and pneumonia 2, wound infection 5, wound infection and sepsis 2, pneumonia 6. On comparison of clinical characteristics between the infected and colonized groups, central venous catheterization was a significant risk factor for development of disease by A. baumannii (P<0.05) and duration of lCU stay was a factor independently associated with A. baumannii infection by logistic regression analysis. An epidemiologic investigation failed to identify the source of infection, but we found 2 of 3 sinks in lCU were heavily contaminated by the organism. Antibiogram of the isolates showed a multi-drug resistance including amikacin, which was found to increase gradually during the course of the outbreak. Ribotyping showed 3 major subtypes: 2A (18 isolates) 2B (16) 2B'(13) and other types (5). CONCLUSION: The findings from this study support the reports from many parts of the world that A. baumannii plays an increasingly important role as one of the major nosocomial pathogens.