Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit

Abstract

We decreased antimicrobial drug consumption in an intensive care unit in Lebanon by changing to colistin monotherapy for extensively drug-resistant Acinetobacter baumanii infections. We saw a 78% decrease of A. baumanii in sputum and near-elimination of bla_oxa-23-carrying sequence type 2 clone over the 1-year study. Non-A. baumanii multidrug-resistant infections remained stable.

Keywords: Acinetobacter baumanii; France; Lebanon; MDR; XDR; antimicrobial resistance; antimicrobial stewardship; bacteria; carbapenem.

Figure 1

Isolation density of Acinetobacter baumanii in sputum cultures versus carbapenem consumption in the intensive care unit (ICU) of Saint Georges Hospital University Medical Center, Beirut, Lebanon, during February 1, 2016–January 31, 2017. Rates are measured per 1,000 patient-days. Dashed arrow represents the beginning of period 2 in which we implemented a carbapenem-sparing regimen. DDD, defined daily dose; PD, patient days.

Figure 2

Isolation density of Acinetobacter baumanii and non–A. baumanii in the intensive care unit (ICU) of Saint Georges Hospital University Medical Center, Beirut, Lebanon, during February 1, 2016–January 31, 2017. Rates are measured in 1,000 patient-days. During period 1, February 1–June 31, 2016, ICU patients received colistin/carbapenem combination therapy for A. baumanii. During period 2, July 1, 2016–January 31, 2017, we implemented a carbapenem-sparing regimen in the ICU.