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Case of the Month - May 2012

Dr Andrew Whitelaw, NHLS, Groote Schuur Hospital

The setting

The case revolves around carbapenem-resistant Acinetobacter baumannii in a paediatric ICU. The ICU has a capacity of 18-22 beds (depending on staffing levels), and is situated in a tertiary academic hospital in the public sector. Table 1, below, shows the number of A. baumannii bacteraemias for 6 month periods in 2010 and 2011, as well as the carbapenem resistance rates.

  2010 (Jan-June) 2010 (Jul-Dec) 2011 (Jan-Jun)  2011 (Jul-Dec)
Number of A. baumannii bacteraemias  23  22  43  19
 Meropenem resistance  74%  86%  82%  27%

Table 1. Acinetobacter bacteraemias 2010-2011, with percentage of isolates resistant to meropenem

The ICU, infection control team and hospital management had been actively trying to reduce the Acinetobacter resistance rates as well as the number of isolates. Measures included strict contact precautions for colonized / infected patients; environmental sampling; staff education; culturing staff hands; reviewing intubation and suctioning practices; antibiotic restrictions.

In July 2011, a review of the pasteurization unit at the hospital was performed. The ventilator circuits used in the ICU were being cleaned and pasteurized on site prior to re-use. At the review, a number of difficulties related to the cleaning of the tubes were identified, primarily that due to the length and nature of the tubes, cleaning them prior to pasteurization was extremely difficult, and there was sometimes residual moisture in the tubes after the drying process. As a result of this review the decision was made by the hospital management to use disposable ventilator circuits in the ICU, rather than re-usable ones.

Question 1: Where is Acinetobacter baumannii normally found?

Continue to Answer 1