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Original Article

Korean J healthc assoc Infect Control Prev 2019; 24(2): 81-87

Published online December 31, 2019 https://doi.org/10.14192/kjicp.2019.24.2.81

Copyright © Korean Society for Healthcare-associated Control and Prevention.

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Colonization Prevalence and Risk Factor Analysis of CarbapenemResistant Acinetobacter baumannii in an Intensive Care Unit without Outbreaks

Young Ah Kim1, Yoon Soo Park2, Sang Sun Lee1, Young Jun Son1, Jeong Hwa Yeon3, Young Hee Seo4, Kyungwon Lee4,5

Departments of Laboratory Medicine1 and Internal Medicine2, Infection Control Unit3, National Health Insurance Service Ilsan Hospital, Goyang, Research Institute of Bacterial Resistance4, Department of Laboratory Medicine5, Yonsei University College of Medicine, Seoul, Korea

Received: May 17, 2019; Revised: November 20, 2019; Accepted: November 25, 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Acinetobacter baumannii is a well-known etiologic agent of a variety of nosocomial infections; the resistance rate to imipenem is surprisingly high in Korea. The colonization of carbapenem-resistant A. baumannii (CRAB) is known to be associated with increased mortality, hospital stay, and cost in intensive care unit (ICU)-admitted patients. In this study, the prevalence, molecular epidemiology, and risk factors of CRAB colonization were evaluated in ICU settings that did not have a current outbreak.
Methods: Consecutive screening for the colonization of CRAB was performed with 291 patients admitted to the surgical or medical ICU within 48 hours for six months (from April to September 2017) in one general hospital (817 beds, Goyang-si, Gyeonggi-do province, Korea). An active surveillance culture (ASC) for CRAB was performed according to the Centers for Disease Control and Prevention protocols with a perirectal swab sample. After DNA extraction, multiplex PCR was performed to detect carbapenemase genes (blaOXA-23-like, blaOXA-24-like, blaOXA51-like, blaOXA-58-like, ISAba1-blaOXA-23-like, and ISAba1-blaOXA-51-like gene). A case-control study was performed to evaluate the risk factors.
Results: Among the 291 patients, the colonization rate of CRAB at ICU admission was 5.2%. The carbapenem resistance mechanism of CRAB colonizers is mostly due to OXA-23-like enzyme production. A risk factor was found to be previous admission to long-term care facilities.
Conclusion: To perform ASC for detecting CRAB in ICU-admitted patients, the colonization rate of CRAB should be considered. Patients with a history of admission to a long-term care facility should be prioritized.

Keywords: Acinetobacter baumannii, Carbapenem resistance, Colonization, Infection control

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