606 Multi drug resistance Acinetobacter baumannii a tough pathogen to eradicate in a resource limited setting

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Sharmila Sengupta, MD , Fortis Healthcare Limited, Delhi, India
Mrinal Sircar , Fortis Healthcare Limited, Delhi, India
Purabi Barman , Fortis Healthcare Limited, Delhi, India
Ravneet Kaur , Fortis Healthcare Limited, Delhi, India
Rajesh Gupta , Fortis Healthcare Limited, Delhi, India
Kuttyamma Joseph , Fortis Healthcare Limited, Delhi, India
Mritunjay Kumar , Fortis Healthcare Limited, Delhi, India
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: MDR-Ab was 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 assessment of infection control procedures such as care of respiratory equipments are important measures to contain the  MDR Ab infection in resource limited settings.