Kontrolle des epidemischen auftretens eines multiresistenten Acinetobacter baumannii-stamms

A multi-resistant Acinetobacter baumannii(MRAB) sensitive only to carbapenems was introduced to the Intensive Care Unit (ICU) of the Atrium medical centre at Heerlen, The Netherlands, by a patient transferred from a hospital in Morocco. Consequently intermittent occurrence of an identical MRAB was noted from September 1999 until May 2001. This strain was detected in 66 ICU patients, in a great variety of clinical specimens, but most patients were colonised. In only a few MRAB caused infection. Over the 20 months period the MRAB attack rate was 7.2 cases per 1.000 patient days, but the impact was considerable as MRAB colonised patients represented on average one-seventh of the ICU's patient days one-fourth of those with mechanical ventilation. All kinds of infection control interventions were applied, including cohorting of patients grouping, barrier precautions and disinfection of the ICU wards, which in the end were successful. Similar "Search and Destroy" measures had been effective in earlier efforts to eradicate an epidemic meticillin-resistant Staphylococcus aureus(MRSA) from the ICU in our hospital. Coordinated cooperation was high on the priority agenda to keep a balance between normal function of the ICU versus the elimination strategy against the MRAB including a review of the impact on clinical (10% less admissions) and financial consequences (approximately € 700.000) plus monitoring of antibiotic use showing 50 % higher consumption of meropenem. A policy to prevent the re-introduction of these resistant microorganisms was implemented via screening cultures at entry by any patients at admission of the ICU. The measures have been proven successfully up till now four years later (year 2005). Altogether we conclude that for a hospital following the Search and Destroy policy a rapid intervention when encountering a multi-resistant strain is of paramount importance.