Reducing Acinetobacter multidrug-Resistant infections in the intensive care unit of a community teaching hospital in Belo Horizonte, Brazil

Background: Health care delivery in the intensive care unit (ICU) continues to face new and difficult challenges. The most important challenges are: the increase in the severity of illness among patients receiving care in the hospital; the increased risk for nosocomial infections, especially pneumonia, urinary tract infection, and bloodstream infection and the emergence of antimicrobial-resistant pathogens has made treating these infections very difficult and, in some cases, impossible

Objective: To evaluate the impact of educational strategies in reducing Acinetobacter baumannii multidrug resistant.

Methods: This is a descriptive study realized in the Risoleta Tolentino Neves Hospital. This is a community teaching hospital where are admitted patients under urgency medical conditions and victims of trauma. In the ICU there are 30 beds to attend medical and surgical adult patients. The infection control professional collected microbiological and epidemiological data between January/2007 to December/2008. There were meetings involving all the healthcare professionals to report the infection data of Acinetobacter multidrug resistant infections, to discuss about the antibiotics policies.

Results: The incidence of Acinetobacter infections were stratified by year from January to December/2007 and from January to December/2008. So the incidence of the nosocomial infections in the first period was 31,4% and in the second 17,4% (p value = 0,012). The same results were noticed with the ventilator associated pneumonia that reduced from 42,2% to 22,1% (p value = 0,001). The infections notified in the others sites reduced but did not show significant difference. The sensibility of the antibiotic increased from 2007 to 2008. For example, the sensibility of ampicilin/sulbactan increased from 32% to 47%. The same occurs with Imipenem that increased from 32% to 45%. The impact could be analyzed by the dose defined daily (DDD)/patient-day reduced too. So many antibiotics showed a reduced consume: amikacin (850,0 - 34,4), cefephime (833-61,4), meropenem (832 – 136), etc. Conclusions: The education program was effective and could be proved by different indicators.