Multi drug resistant Acinetobacter baumannii - a tough pathogen to eradicate in a resource limited setting

Background: Multi drug resistant Acinetobacter baumannii (MDR Ab) is emerging as an important hospital associated infection (HAI). We are reporting a cluster of HAI in a tertiary care hospital in India and interventions to control the outbreak. Objective: To describe an epidemiological investigation of cluster of cases of MDR-Ab.
Methods:   In July 2008 an index patient was transferred to our hospital with pneumonia & septicemia.  An epidemiological investigation was conducted following a cluster of infections with MDR-Ab (similar strain as the index case) that occurred in 2 adjacent ICUs from Sept 2008. Investigation included review of microbiology reports and the infection control policies and procedures. Results: MDRAb were isolated in 157 patients with clinical diagnosis as mentioned in Table below.They were isolated from lower respiratory tract infections , blood and  surgical site infections (SSI). Invasive infections leading to mortality in 29 (18.47%). Active surveillance by culture showed contamination of the respiratory equipments. Revision of disinfection policy and compliance with infection  control measures such as contact precautions & hand hygiene compliance were reinforced. These measures were met with limited success.
Table showing patient with HAIs.

No of patients	157
Pneumonia	72(45.85%)
Pneumonia + septicemia	17(10.82%)
Pneumonia + septicemia + SSI	11(7%)
Septicemia + SSI	8(5%)
Septicemia	31(19.75%)
SSI	18(11.46%)

Conclusions:

MDR-Ab is now well established nosocomial pathogen in critical care units.Vigilance active surveillance  and on going assesment of infection control procedures such as care of respiratory equipments are important measures to contain the  MDR Ab infection in resource limited settings.