A-L Munier1, L Biard2, C Rousseau3, M Legrand4, M Lafaurie5, A Lomont3, J-L Donay3, E de Beaugrenier6, R Flicoteaux2, A Mebazaa7, M Mimoun8, J-M Molina5. 1. Infectious Disease Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France. Electronic address: anne-lise.munier@aphp.fr. 2. Department of Biostatistics, St Louis Hospital, APHP and University Paris Diderot, Paris, France. 3. Microbiology Department, St Louis Hospital, APHP and EA4065, University Paris Descartes, Paris, France. 4. Department of Anesthesiology, Critical Care and Burn Unit, St Louis Hospital, APHP and University Paris Diderot, Paris, France; INSERM U942, France. 5. Infectious Disease Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France. 6. Pharmacy Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France. 7. Department of Anesthesiology, Critical Care and Burn Unit, St Louis Hospital, APHP and University Paris Diderot, Paris, France. 8. Plastic Surgery Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France.
Abstract
BACKGROUND: Multidrug-resistant Acinetobacter baumannii (MR-AB) can cause outbreaks in a burns unit. AIM: To study the incidence, risk factors and outcome of MR-AB colonization during an outbreak. METHODS: A prospective study was conducted from April to November 2014 in a burns unit in Paris. Weekly surveillance cultures of patients and their environment were performed. MR-AB acquisition, discharge, or death without MR-AB colonization were considered as competing events. To identify risk factors for colonization, baseline characteristics and time-dependent variables were investigated in univariate and multivariate analyses using Cox models. MR-AB strains were genotypically compared using multi-locus sequence typing. FINDINGS: Eighty-six patients were admitted in the burns unit during the study period. Among 77 patients without MR-AB colonization at admission, 25 (32%) acquired MR-AB with a cumulative incidence of 30% at 28 days (95% CI: 20-40). Median time to MR-AB acquisition was 13 days (range: 5-34). In multivariate analysis, risk factors for MR-AB acquisition were ≥2 skin graft procedures performed [hazard ratio (HR): 2.97; 95% confidence interval (CI): 1.10-8.00; P = 0.032] and antibiotic therapy during hospitalization (HR: 4.42; 95% CI: 1.19-16.4; P = 0.026). A major sequence type of MR-AB (ST2) was found in 94% and 92% of patients and environmental strains, respectively, with all strains harbouring the blaOXA-23 gene. MR-AB colonization increased length of hospitalization (HR: 0.32; 95% CI: 0.17-0.58; P = 0.0002) by a median of 12 days. CONCLUSION: A high incidence of MR-AB acquisition was seen during this outbreak with most strains from patients and their environment belonging to single sequence type. MR-AB colonization was associated with more skin graft procedures, antibiotic use, and prolonged hospitalization.
BACKGROUND: Multidrug-resistant Acinetobacter baumannii (MR-AB) can cause outbreaks in a burns unit. AIM: To study the incidence, risk factors and outcome of MR-AB colonization during an outbreak. METHODS: A prospective study was conducted from April to November 2014 in a burns unit in Paris. Weekly surveillance cultures of patients and their environment were performed. MR-AB acquisition, discharge, or death without MR-AB colonization were considered as competing events. To identify risk factors for colonization, baseline characteristics and time-dependent variables were investigated in univariate and multivariate analyses using Cox models. MR-AB strains were genotypically compared using multi-locus sequence typing. FINDINGS: Eighty-six patients were admitted in the burns unit during the study period. Among 77 patients without MR-AB colonization at admission, 25 (32%) acquired MR-AB with a cumulative incidence of 30% at 28 days (95% CI: 20-40). Median time to MR-AB acquisition was 13 days (range: 5-34). In multivariate analysis, risk factors for MR-AB acquisition were ≥2 skin graft procedures performed [hazard ratio (HR): 2.97; 95% confidence interval (CI): 1.10-8.00; P = 0.032] and antibiotic therapy during hospitalization (HR: 4.42; 95% CI: 1.19-16.4; P = 0.026). A major sequence type of MR-AB (ST2) was found in 94% and 92% of patients and environmental strains, respectively, with all strains harbouring the blaOXA-23 gene. MR-AB colonization increased length of hospitalization (HR: 0.32; 95% CI: 0.17-0.58; P = 0.0002) by a median of 12 days. CONCLUSION: A high incidence of MR-AB acquisition was seen during this outbreak with most strains from patients and their environment belonging to single sequence type. MR-AB colonization was associated with more skin graft procedures, antibiotic use, and prolonged hospitalization.
Authors: C Baier; R Ipaktchi; E Ebadi; H-O Rennekampff; H-M Just; P M Vogt; F-C Bange; K Suchodolski Journal: Ann Burns Fire Disasters Date: 2018-09-30
Authors: Rogério Coutinho das Neves; Márcia Renata Mortari; Elisabeth Ferroni Schwartz; André Kipnis; Ana Paula Junqueira-Kipnis Journal: Toxins (Basel) Date: 2019-04-10 Impact factor: 4.546