1582. Acinetobacter baumannii: where is it all coming from?
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background:

Acinetobacter baumannii (Ab) is frequently identified in ICUs and infections lead to high morbidity and mortality due to limited treatment options. Environmental contamination increases the risk of cross transmission. Our goal is to identify where colonized/infected patients (pts) are coming from in our community and to further develop a screening/re-isolation process to prevent potential cross transmission of multi-drug resistant (MDR) Abin high risk settings.

Methods:

We retrospectively reviewed laboratory records from all pts with a positive (+) MDR Ab culture from 1/1/2012 to 12/31/2012, defined as resistant to cephalosporins, combination penicillins, fluoroquinolones and/or aminoglycosides. Records were reviewed for trends related to demographics, domicile prior to admission (PTA), admission location in hospital and risk factors for infection.  Pts admitted to the MICU, coming from long term care (LTC) were placed in contact isolation; a respiratory (for any organism) plus another cutaneous site (wound, axilla or groin) was tested for Ab  only. Compliance with the MICU process was unknown; so expansion to areas beyond the MICU has not been implemented.

Results:

Fifty two pts were identified with MDR Ab among 66 unique admissions in 2012. Mean age was 51 (range of 23 to 78 years).   Thirty nine/66 (59%) admissions involved an ICU stay. Thirty three/66 (50%) pts had a positive culture on or prior to hospital day (HD) 2. The majority of pts 37/66 (56%) came from an extended care facility (ECF); over 60% came from 2 specific LTC facilities, ECF A 17/37 (45.9%) and ECF B 6/37 (16%). In those who came from home, there was a mean of 16 HD prior to the first + culture; all other domiciles ranged from 3.9 to 6 days. The most common co-morbid condition was respiratory; 37/66 (51%) were intubated during admission or had had a tracheostomy PTA.  In 2012, 58 pts were screened; 3 respiratory sites were positive for Ab, all had correspondingly negative cutaneous sites .  

Conclusion:

There is a high incidence of community onset MDR Ab in pts coming primarily from 2 ECFs, specializing in chronic ventilator management. This is a population to target screening of respiratory and an  alternative secondary screening site to reduce the potential for cross transmission of Ab.

Jennica Johns, MD (as of 5/2/2013), Internal Medicine, The Ohio State University's Wexner Medical Center, Columbus, OH and Julie E. Mangino, MD, Internal Medicine Dept of Infectious Disease, The Ohio State University Wexner Medical Center, Columbus, OH

Disclosures:

J. Johns, None

J. E. Mangino, None

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