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435 Multidrug-Resistant Acinetobacter baumannii High Endemic Levels amongst Brazilian Hospitals

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Andreza Martins, MSc , Medical Sciences Post-Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, Porto Alegre, Brazil
Ricardo S. Kuchenbecker, PhD , Graduate Studies Program in Epidemiology, and Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Andrea Gomes , Medical Sciences Post-Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, Porto Alegre, Brazil
Anelise Breier , Medical Sciences Post-Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, Porto Alegre, Brazil
Afonso L Barth , Medical Sciences Post-Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, Porto Alegre, Brazil
Background: In Brazil, Acinetobacter baumannii (Ab) has been emerging as a multidrug-resistant (MDR) nosocomial pathogen since 1993, mainly at Intensive Care Units (ICU), resulting in an endemic pathogen. Healthcare-acquired infections (HAI) caused by MDR Ab have been important cause of morbidity in hospitals worldwide. These opportunistic pathogens are responsible for ventilator-associated pneumonia, bacteremia, surgical wound and urinary tract infections, amongst others, particularly in patients under intensive care . In Porto Alegre there was an increase of the infections caused by MDR Ab during the year of 2007.

Objective: To describe and compare the rates of infection of MDR Ab reported by 25 hospitals between July 2007 and December 2008 in Porto Alegre, Southern of Brazil.

Methods: Since July 1st 2007, the local health department at Porto Alegre implemented a surveillance information system of notifiable cases of HAI due to MDR Ab. Data from all MDR Ab cases of 25 hospitals during the period from July 1st 2007 to December 31st, 2008, were used in this study. All 25 hospitals in the city were requested to inform whenever an HAI due do MDR Ab was detected. The form gathered information on demographic, clinical findings and outcome of patients, according to case definition.  HAI due to MDR Ab was defined as an infection that occurred more than 48 hours after hospital admission in accordance with NNIS criteria.

Results: A total of 609 documented HAI due to A. baumannii were reported from the 25 city hospitals during the 18-month surveillance period. The majority of patients (66.5%) were 51-99 years old, men (61.8%), had made surgery (54.9%), had used central venous catheter (85.2%), urinary catheter (85.3%), mechanical ventilation (72.4%) and had respiratory disease (77.3%). The use of previous antimicrobial therapy (last 90 days) was documented in 95.4% of cases and 78.9% of patients were treated at  the public health system.  The period with high number of cases was in the summer when the rate of infection reached 10.04/1000 patient-days in contrast to rates of 3.00/1000 patient-days (1.95-4.05; mean ± 2SV)   in other periods.

Conclusions: The data of our study  suggest that HAI caused by A. baumannii is associated to severity of patients. In our city, the peak of cases occurred in the summer althought these infections can be considered endemic. Thus, infection control is basic to reduced dissemination this pathogen.