At one Israeli hospital, screening readmitted patients with prior positive clinical cultures for carbapenem-resistant Acinetobacter baumannii, or CRAB, showed that CRAB colonization was persistent for up to 285 days.
“Furthermore, we found widespread contamination of persistent carriers' immediate environment,” Amir Nutman, MD, MPH, a physician at Tel Aviv Sourasky Medical Center and the National Center for Infection Control and Antibiotic Resistance in Tel Aviv, told Infectious Disease News. “These patients may be the source of hospital outbreaks if not identified early and put on contact isolation upon return admission to prevent transmission of CRAB.”
CRAB is a leading cause of deadly health care-associated infections, but there is limited information regarding the “natural history of carriage and risk factors for extended duration of carriage,” Nutman and colleagues wrote.
Between June 2015 and November 2017, they researchers “evaluated the risk of CRAB carriage upon first readmission among patients previously diagnosed with CRAB.” The study included 38 adult patients with a clinical CRAB culture during a prior hospitalization. Patients were required to be screened within 7 days upon first readmission, and samples were collected from both patients and their immediate surroundings.
Nutman and colleagues observed a median of 59 days from discharge to readmission (interquartile range, 35-147) and a median of 2 days from readmission to screening. They reported that 31.6% (n = 12) of cultures were positive for CRAB.
Compared with patients who screened negative, patients with a positive culture were more likely to have been admitted with an infection-related diagnosis (75% vs. 38.5%; P = .04), to have arrived from an institution (66.7% vs. 23.1%; P = .01) and to have a feeding tube (41.7% vs. 7.7%; P = .02), the researchers reported.
Among the beds of the 12 patients with positive cultures, 11 were positive for CRAB. Additionally, 50% of cabinets and 57% of medical equipment associated with these patients were positive for CRAB.
Up to 58 days after discharge, the risk for CRAB carriage was 42% (95% CI, 24%-59%). Up to 141 days after discharge, it was 33% (95% CI, 17%-51%) and up to 285 days, the risk was 14% (95% CI, 3%-34%), Nutman and colleagues reported.
“Screening for CRAB upon readmission is feasible and may be warranted in specific settings; however, screening guidelines are beyond the scope of this study,” Nutman said. “Further research is needed in order to build evidence on which to base CRAB screening recommendations.” – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.