Surveillance for nosocomial pathogens in our ICU

Introduction

The use of contact precautions is recommended to reduce the transmission of these pathogens. However, there is little research regarding the relationship between the rate of patients with culture- positive findings for Acinetobacter baumannii and the consumption of hand disinfectant. The objective of this study was therefore to evaluate trends in nosocomial bacterial detection, including A. baumannii, and the use of hand disinfectant in our ICU.

Methods

A single-center, retrospective, observational study was carried out. The results of all cultures (sputum, urine, blood, and so forth) were used to examine trends in the detection of microbiology in our ICU over a 4-year period from April 2009 through March 2013. The rate of culture-positive patients, frequency of use of hand disinfectant and the antimicrobial use density (AUD) values were investigated for the described periods and compared between the early period group (April 2009 to March 2011) and the late period group (April 2011 to March 2013).

Results

We encountered 3,302 patients in our ICU during this period. No patients with culture-positive findings for multidrug-resistant A. baumannii were identified in this study. The rates of patients with culture-positive findings for multidrug-resistant Pseudomonas aeruginosa (0%o vs. 0.05%o per 1,000 patient-days, P = 0.99) and P. aeruginosa (6.96% vs. 7.21% per 1,000 patient-days, P = 0.7) were not significantly different between the early period group and the late period group. The rates of patients with culture-positive findings for MrSA (6.96% vs. 8.94% per 1,000 patient-days, P < 0.05) and A. baumannii (4.98% vs. 6.51% per 1,000 patient-days, P < 0.05) were significantly higher in the late period group than in the early period group. The frequency of use of hand disinfectant (99.5 ml/patient- day vs. 85 ml/patient-day, P < 0.05) was significantly lower in the late period group. The AUD values for fluoroquinolones (34 vs. 31.1 defined daily doses/1,000 bed-days, P = 0.69), third-generation cephalosporins (23.5 vs. 38.4 defined daily doses/1,000 bed-days, P = 0.55) and glycopeptides (34.9 vs. 35.9 defined daily doses/1,000 bed-days, P = 0.66) were not significantly different between the early period group and the late period group. However, the AUD values for carbapenems were significantly higher in the early period group (40.6 vs. 71.8 defined daily doses/1,000 bed-days, P < 0.05).

Conclusion

Improving compliance with hand hygiene and appropriate use of carbapenems is important for decreasing the rate of patients with culture-positive findings for MRSA and A. baumannii.