Rapid screening and early precautions for carbapenem-resistant Acinetobacter baumannii carriers decreased nosocomial transmission in hospital settings: a quasi-experimental study
Abstract Background Active surveillance has the potential to prevent nosocomial transmission of carbapenem-resistant Acinetobacter baumannii (CRAB). We assessed whether rapid diagnosis using clinical specimen-direct loop-mediated isothermal amplification (LAMP), a rapid molecular diagnostic assay, a...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-06-01
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| Series: | Antimicrobial Resistance and Infection Control |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13756-019-0564-9 |
| _version_ | 1818524022309126144 |
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| author | Norihisa Yamamoto Shigeto Hamaguchi Yukihiro Akeda Pitak Santanirand Narong Chaihongsa Suntariya Sirichot Suwichak Chiaranaicharoen Hideharu Hagiya Kouji Yamamoto Anusak Kerdsin Kazuhisa Okada Hisao Yoshida Shigeyuki Hamada Kazunori Oishi Kumthorn Malathum Kazunori Tomono |
| author_facet | Norihisa Yamamoto Shigeto Hamaguchi Yukihiro Akeda Pitak Santanirand Narong Chaihongsa Suntariya Sirichot Suwichak Chiaranaicharoen Hideharu Hagiya Kouji Yamamoto Anusak Kerdsin Kazuhisa Okada Hisao Yoshida Shigeyuki Hamada Kazunori Oishi Kumthorn Malathum Kazunori Tomono |
| author_sort | Norihisa Yamamoto |
| collection | DOAJ |
| description | Abstract Background Active surveillance has the potential to prevent nosocomial transmission of carbapenem-resistant Acinetobacter baumannii (CRAB). We assessed whether rapid diagnosis using clinical specimen-direct loop-mediated isothermal amplification (LAMP), a rapid molecular diagnostic assay, and subsequent intervention, could reduce CRAB nosocomial transmission in intensive care units (ICUs). Methods A before and after (quasi-experimental) study was conducted in two ICUs at the Mahidol University Faculty of Medicine Ramathibodi Hospital with 3 months of observational period followed by 9 months of interventional period. All patients were screened for CRAB using both the culture and LAMP method from rectal swab and/or bronchial aspirates (intubated patients only) upon admission, weekly thereafter, and upon discharge. During the pre-intervention period, we performed contact precautions based on culture results. In contrast, during the intervention period, we initiated contact precautions within a few hours after sample collection on the basis of LAMP results. Results A total of 1335 patients were admitted to the ICUs, of which 866 patients (pre-intervention period: 187; intervention period: 679) were eligible for this study. Incidence rate of CRAB infection decreased to 20.9 per 1000 patient-days in the intervention period from 35.2 in the pre-intervention period (P < 0.02). The calculated hazard ratio of CRAB transmission was 0.65 (95% confidence interval [CI], 0.44–0.97). Risk factors for CRAB acquisition included exposure to carbapenem (hazard ratio, 2.54 [95% CI: 1.61–5.57]). Conclusions LAMP screening for CRAB upon ICU admission proved feasible for routine clinical practice. Rapid screening using LAMP followed by early intervention may reduce CRAB transmission rates in ICUs when compared to conventional intervention. |
| first_indexed | 2024-12-11T05:52:02Z |
| format | Article |
| id | doaj.art-11a487b66d024487ace74e83bbda6e41 |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-12-11T05:52:02Z |
| publishDate | 2019-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-11a487b66d024487ace74e83bbda6e412022-12-22T01:18:47ZengBMCAntimicrobial Resistance and Infection Control2047-29942019-06-01811810.1186/s13756-019-0564-9Rapid screening and early precautions for carbapenem-resistant Acinetobacter baumannii carriers decreased nosocomial transmission in hospital settings: a quasi-experimental studyNorihisa Yamamoto0Shigeto Hamaguchi1Yukihiro Akeda2Pitak Santanirand3Narong Chaihongsa4Suntariya Sirichot5Suwichak Chiaranaicharoen6Hideharu Hagiya7Kouji Yamamoto8Anusak Kerdsin9Kazuhisa Okada10Hisao Yoshida11Shigeyuki Hamada12Kazunori Oishi13Kumthorn Malathum14Kazunori Tomono15Department of Infection Control and Prevention, Osaka University Graduate School of MedicineDepartment of Infection Control and Prevention, Osaka University Graduate School of MedicineDepartment of Infection Control and Prevention, Osaka University Graduate School of MedicineFaculty of Medicine Ramathibodi Hospital, Mahidol UniversityFaculty of Medicine Ramathibodi Hospital, Mahidol UniversityFaculty of Medicine Ramathibodi Hospital, Mahidol UniversityFaculty of Medicine Ramathibodi Hospital, Mahidol UniversityDepartment of Infection Control and Prevention, Osaka University Graduate School of MedicineDepartment of Medical Statistics, Graduate School of Medicine, Osaka City UniversityFaculty of Public Health, Kasetsart UniversityResearch Institute for Microbial Diseases, Osaka UniversityDepartment of Infection Control and Prevention, Osaka University Graduate School of MedicineResearch Institute for Microbial Diseases, Osaka UniversityInfectious Disease Surveillance Center, National Institute of Infectious DiseasesFaculty of Medicine Ramathibodi Hospital, Mahidol UniversityDepartment of Infection Control and Prevention, Osaka University Graduate School of MedicineAbstract Background Active surveillance has the potential to prevent nosocomial transmission of carbapenem-resistant Acinetobacter baumannii (CRAB). We assessed whether rapid diagnosis using clinical specimen-direct loop-mediated isothermal amplification (LAMP), a rapid molecular diagnostic assay, and subsequent intervention, could reduce CRAB nosocomial transmission in intensive care units (ICUs). Methods A before and after (quasi-experimental) study was conducted in two ICUs at the Mahidol University Faculty of Medicine Ramathibodi Hospital with 3 months of observational period followed by 9 months of interventional period. All patients were screened for CRAB using both the culture and LAMP method from rectal swab and/or bronchial aspirates (intubated patients only) upon admission, weekly thereafter, and upon discharge. During the pre-intervention period, we performed contact precautions based on culture results. In contrast, during the intervention period, we initiated contact precautions within a few hours after sample collection on the basis of LAMP results. Results A total of 1335 patients were admitted to the ICUs, of which 866 patients (pre-intervention period: 187; intervention period: 679) were eligible for this study. Incidence rate of CRAB infection decreased to 20.9 per 1000 patient-days in the intervention period from 35.2 in the pre-intervention period (P < 0.02). The calculated hazard ratio of CRAB transmission was 0.65 (95% confidence interval [CI], 0.44–0.97). Risk factors for CRAB acquisition included exposure to carbapenem (hazard ratio, 2.54 [95% CI: 1.61–5.57]). Conclusions LAMP screening for CRAB upon ICU admission proved feasible for routine clinical practice. Rapid screening using LAMP followed by early intervention may reduce CRAB transmission rates in ICUs when compared to conventional intervention.http://link.springer.com/article/10.1186/s13756-019-0564-9Carbapenem-resistant Acinetobacter baumannii (CRAB)Nosocomial transmissionLAMP (Loop-mediated isothermal amplification), Rapid molecular diagnosis.Rapid intervention, Intensive care unit. |
| spellingShingle | Norihisa Yamamoto Shigeto Hamaguchi Yukihiro Akeda Pitak Santanirand Narong Chaihongsa Suntariya Sirichot Suwichak Chiaranaicharoen Hideharu Hagiya Kouji Yamamoto Anusak Kerdsin Kazuhisa Okada Hisao Yoshida Shigeyuki Hamada Kazunori Oishi Kumthorn Malathum Kazunori Tomono Rapid screening and early precautions for carbapenem-resistant Acinetobacter baumannii carriers decreased nosocomial transmission in hospital settings: a quasi-experimental study Antimicrobial Resistance and Infection Control Carbapenem-resistant Acinetobacter baumannii (CRAB) Nosocomial transmission LAMP (Loop-mediated isothermal amplification), Rapid molecular diagnosis. Rapid intervention, Intensive care unit. |
| title | Rapid screening and early precautions for carbapenem-resistant Acinetobacter baumannii carriers decreased nosocomial transmission in hospital settings: a quasi-experimental study |
| title_full | Rapid screening and early precautions for carbapenem-resistant Acinetobacter baumannii carriers decreased nosocomial transmission in hospital settings: a quasi-experimental study |
| title_fullStr | Rapid screening and early precautions for carbapenem-resistant Acinetobacter baumannii carriers decreased nosocomial transmission in hospital settings: a quasi-experimental study |
| title_full_unstemmed | Rapid screening and early precautions for carbapenem-resistant Acinetobacter baumannii carriers decreased nosocomial transmission in hospital settings: a quasi-experimental study |
| title_short | Rapid screening and early precautions for carbapenem-resistant Acinetobacter baumannii carriers decreased nosocomial transmission in hospital settings: a quasi-experimental study |
| title_sort | rapid screening and early precautions for carbapenem resistant acinetobacter baumannii carriers decreased nosocomial transmission in hospital settings a quasi experimental study |
| topic | Carbapenem-resistant Acinetobacter baumannii (CRAB) Nosocomial transmission LAMP (Loop-mediated isothermal amplification), Rapid molecular diagnosis. Rapid intervention, Intensive care unit. |
| url | http://link.springer.com/article/10.1186/s13756-019-0564-9 |
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