Carbapenem-resistant Acinetobacter baumannii (CRAB) was brought into the ICU, in Hangzhou, China, on multiple occasions as patients were admitted, creating a large “reservoir” of the bacteria which contaminated beds and equipment.
Of 35 CRAB-positive patients in the study, 14 acquired CRAB during their ICU stay. Samples of the drug-resistant bacteria were found more frequently in bed-unit environments (54.6 percent) than in patients (24.1 percent), with ventilators (27.9 percent) and dispensing trolleys (25.6 percent) most likely to yield samples of CRAB.
Publishing their findings in The Lancet Regional Health - Western Pacific, the international group of researchers led by the University of Birmingham calls for urgent measures to help prevent hospitals from becoming infected with the bacteria.
Study co-author Alan McNally, PhD, professor at the University of Birmingham, commented: “CRAB poses a serious risk to hospitalized patients and can cause severe disease including pneumonia, urinary tract infection, bacteremia, meningitis, and soft tissue infections—all of which can be very difficult to treat due to the bacteria’s multidrug-resistance.” McNally said, “The quantity of CRAB found in this ICU highlights the urgent need for targeted infection prevention and control measures in healthcare facilities where such large accumulations of the bacteria are likely so that we can stem the global spread of this pathogen.”
Recommendations to tackle CRAB infection
The study highlights the environment’s important role in CRAB persistence and eventual acquisition by patients. Researchers call for the build-up of the bacteria to be tackled with infection prevention and control measures, including:
Thorough and regular deep-cleaning of surfaces touched by patients and staff
Isolation of patients known to carry CRAB
Minimization of patient relocation between beds
Enhanced staff hand-washing protocols.
Researchers sampled the entire ICU, including staff, patients, and the environment, to reveal a remarkable diversity of CRAB in this setting, which was introduced to the unit as patients were admitted, driving the bacteria’s spread within the ICU.
CRAB can persist for prolonged periods on hospital surfaces and medical equipment, and colonize patients within 48 hours of admission—facilitated by hospital staff, shared equipment, airflow, and plumbing. Outbreaks of CRAB can require interventions or changes to infrastructure that impose clinical, logistical, and financial burdens.
Antibiotic-resistant infections are a major threat to global public health. CRAB infections are found worldwide with severely limited treatment options prompting the World Health Organisation to designate CRAB a priority organism for which novel therapeutics are urgently required.
McNally added, “In the absence of new therapeutic agents, effective CRAB IPC strategies are vital if we are to limit the morbidity and mortality caused by the bacteria in hospitals. We must develop a thorough understanding of the persistence, transmission, and evolution of CRAB populations in such environments.”
- This press release was originally published on the University of Birmingham website