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Incidence of Resistant Infections in the Surgical ICU: the Impact of Responding to Acinetobacter Outbreaks
Jayaraman, S., Klompas, M., Bascom, M., Liu, X., Rogers, S.O., Askari, R.
Objective: We hypothesized that response to a 2004 multi-drug resistant Acinetobacter (MDRA) outbreak in our general surgery and trauma ICUs subsequently decreased the rates of MRSA, VRE and C. difficile.
Design: Retrospective review of prospectively collected infection control data.
Setting: University Hospital.
Patients: All patients admitted to the General, Trauma and Thoracic Surgery and Medical ICU from 6/04-5/05.
Interventions: Response to MDRA outbreak in Nov 2004.
Main Outcome Measure: Incidence of MRSA, VRE, and C.difficile were calculated for 6-months before and after the outbreak. We created a composite endpoint of “any resistant pathogen” defined as MRSA, or VRE, or C.difficile and compared each unit’s rates across time periods using the Wilcoxon’s signed rank test.
Results: 215 cases of resistant pathogens occurred over the 12 months: 95 cases before & 120 after the outbreak. The General Surgery ICU showed a significant decrease in incidence rates after the outbreak response, however the rate of resistant pathogens in the Trauma ICU did not change despite the intervention. The Medical & Thoracic ICUs, which were unaffected by the MDRA outbreak, showed steady rates throughout the study period.
Conclusion: Aggressive infection control response to MDRA appears to reduce the rates of other resistant pathogens although it is not equally effective across units. The lack of rate reduction in the trauma ICU is worrisome. Conventional infection control strategies may not be adequate for critically ill trauma patients. We plan to compare these results to a 2011 outbreak to determine if the same pattern persists.