Starting in 2014, a bundle-based surveillance method for the prevention and detection of the main hospital-acquired infections was introduced in our hospital. In August 2014 an increase in the number of cases of S. maltophilia VAP in the ICU was noticed.
A case-control study was conducted to identify the risk factors related to the outbreak. We performed a measurement of the adherence to the VAP prevention bundle in the ICU. Cleaning and disinfection practices were reviewed also. To increase the sample size and statistical power of our analysis of risk factors, we included all cases of VAP due to S. maltophilia in the last five years.
We identified 15 cases of S maltophilia VAP in the ICU from 2010 to 2014. All of the isolates were obtained from bronchoalveolar lavage samples and only one was resistant to quinolones and trimethoprim+sulfamethoxazole. We included all the patients (n=154) with VAP due to other etiologies as controls. There was no difference in age, gender or disease severity between the two groups. The variables identified as risk factors were: hemodialysis (OR=12.6, p=<0.001), parenteral nutrition (OR=7.45, p=<0.001), number of days of use of antibiotics prior to the event (17 vs. 8 days, p= <0.01), previous bronchoscopy (OR=5.25, p=0.01) and tracheostomy (OR=3.9, p=0.02). There was no difference in mortality (OR=0.85, p=0.88). Our clinical and epidemiological analysis did not suggest a common source for this outbreak. Adherence to the VAP prevention bundle (especially mouth cleansing with 0.12% chlorhexidine antiseptic solution) had decreased significantly (50%), coinciding with the outbreak. After improving the adherence to the bundle, no new cases have been identified since January 2015.
This experience allowed us to identify the component of the VAP prevention bundle that needed to be reinforced. Other risk factors for the acquisition of S. maltophilia (such as invasive procedures) were identified but were not modifiable in our ICU. Therefore, our bundle-based surveillance tool allowed us to detect and control the outbreak after the improvement of simple, low-cost preventive measures.
E. Ochoa Hein,
J. A. Ruiz-Quiñones, None
E. Rivero Sigarroa, None
A. Ponce De León, None
J. Sifuentes-Osornio, None
A. Galindo-Fraga, None
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