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337
Nosocomial Transmission of Carbapenem-Resistant Acinetobacter baumannii (CRAb) among ICU Patients Detected by CRAb-LAMP

Session: Poster Abstract Session: Multidrug-resistant Organisms: Epidemiology and Prevention
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Nosocomial infections of drug-resistant bacteria are a leading cause of morbidity and mortality worldwide. Carbapenem-resistant Acinetobacter baumannii (CRAb) is one of the most important microorganisms in Thailand. The rapid and sensitive detection of this pathogen is required not only for proper therapy but also for infection control measures. However, conventional culture method takes time and has poor sensitivity. We established CRAb-LAMP method for detecting blaOXA-23-positive CRAb, which accounts for approximately 95% of CRAb in Thailand. This method enables direct analysis of clinical specimens, with results available within 40 minutes of sample collection. In this study, we used CRAb-LAMP for active surveillance among ICU patients in Thai hospital and surveyed nosocomial infection.

Methods: The study took place in medical ICU and surgical ICU of Faculty of Medicine Ramathibodi Hospital from Dec. 2013 to Feb. 2014. All the patients who stayed more than 2 days were included and screened for CRAb with LAMP by rectal swab and/or sputum (intubated patient only) on admission, day7 and discharge. If the either sample showed positive, we defined patient as positive.

Results: Throughout the research period, 794 samples were collected and the sensitivity of LAMP was 100% and its specificity was 88.9%, using the culture method as the gold standard. 334 patients were admitted to the either ICU and 155 (medical ICU: 108, surgical ICU: 47) were eligible in this study. The average length of stay in ICU was 8.9 days. The rate of CRAb-positive on admission was 12.3% (medical ICU: 13.9, surgical ICU: 8.5). The rate of CRAb acquisition was 26.8 per 1000 patient days (medical ICU: 31.0, surgical ICU: 17.2) and 24.3% (medical ICU: 29.0, surgical ICU: 14.0) of the patients was transmitted during ICU stay.

Conclusion: Active surveillance is important for identifying hidden reservoirs. Our research confirmed that CRAb-LAMP with its high sensitivity and rapidity enabled us to find positive patients early and to investigate the incidence of nosocomial transmission easily. We have started to make appropriate interventions for the CRAb-positive patients from the LAMP result and investigate the efficacy.

Norihisa Yamamoto, MD1, Shigeto Hamaguchi, MD, PhD1, Yukihiro Akeda, PhD2, Pitak Santanirand, PhD3, Anusak Kerdsin, PhD4, Masafumi Seki, MD, PhD1, Wantana Paveenkittiporn, PhD4, Kumthorn Malathum, MD5, Kazunori Oishi, MD, PhD6 and Kazunori Tomono, MD, PhD1, (1)Division of Infection Control and Prevention, Osaka University Graduate School of Medicine, Suita, Japan, (2)Laboratory of Clinical Research on Infectious Diseases, Research Institute for Microbial Diseases, Osaka University, Suita, Japan, (3)Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, (4)General Bacteriology Section, National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Bangkok, Thailand, (5)Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, (6)Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan

Disclosures:

N. Yamamoto, None

S. Hamaguchi, None

Y. Akeda, None

P. Santanirand, None

A. Kerdsin, None

M. Seki, None

W. Paveenkittiporn, None

K. Malathum, None

K. Oishi, None

K. Tomono, None

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