Abstract
Antibiotic-resistant bacterial infections are a major problem at the national level, especially for patients admitted to hospitals. Additionally, patients with infections have a high mortality rate, prolonged length of hospital stay, and high hospital cost. The most common concerned gram-negative bacteria as the major problem is Acetobacter baumannii and Enterobacteriaceae, particularly the strain which is resistant to carbapenam antibiotics. Objectives To study the clinical and molecular epidemiology of carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae in the lower southern hospital network as well as spatiotemporal analysis of these two species from clinical specimens and from screening in patients with systemic survey as well as from the hospital environments in each hospital and in the hospital network. To measure the efficacy of infection control strategies based on the investigational data. Methods To collect the specimens of carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae from clinical practices and surveillance and do the laboratory to identify molecular strain of those specimen. Clinical data was used to analyzed the factors influencing mortality as well as probability for colonization of those bacteria. Clinical and non-clinical outcomes were compared between the patient with colonization and those without colonization. Molecular data and demographic data was used to performed spatio-temporal analysis. The number of the patients infected with these two bacteria was compared before and after intervention. Results From February 2019 to July 2019, there is the distribution of both bacteria every hospital in the network as well as in the whole of network with identically detection of molecular closeness and spatio-temporal relation. The infection due to both bacteria had relatively high mortality and unfavorable economic burden. Factors influencing mortality is Acute Physiology and Chronic Health Evaluation II (APACHE II) score and appropriate empirical antibiotics. Among of the patients with colonization of these two bacteria, unfavorable clinical outcomes and particularly high hospital costs were identified. The significantly associated factors influencing colonization is previous use of antibiotics, particularly carbapenems even the short duration of administration. The number of cases infected with carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae were significantly decreased after implement of infection control measures based on the finding from surveillance data. Conclusion Systematic control of the use of antibiotics is sufficient to reduce the infection due to carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae. Measures for screening patients before admission is potentially necessary supplementary measures.
