Multidrug-resistant Acinetobacter baumannii susceptible only to colistin outbreak in a cardiac surgical intensive care unit
Bibliographic record
Abstract
Gram-negative bacilli including multidrug-resistant Acinetobacter baumannii (MDR-AB) are responsible for severe ICU-acquired infections, mainly pneumonia and bacteraemia. The aim of this study was to determine the incidence and mortality of this multiresistant strain of Acinetobacter in patients undergoing cardiac surgery, to elucidate the effectiveness of treatment with colistin and to identify whether additional measures were able to prevent and control the dissemination of MDR-AB isolates in our institution. A total of 1,451 patients attended the surgical ICU (SICU) after cardiovascular surgery from 1 September 2005 to 31 August 2006. We reviewed the prophylactic measures of the SICU and tried to identify epidemiological links between MDR-AB-infected patients. We implemented a two-scale multiple program. Scale 1 included classical infection control measures (that is, strict contact and droplet isolation, surveillance of throat, nasal and anal flora for MDR pathogens on all patients transferred from other hospitals, separate nursing staff for each infected or colonized case and strict antibiotic policy), while Scale 2 referred to geographic isolation of MDR-AB cases with exclusive medical and nursing personnel, use of separate supplies and facilities and intense environmental surveillance. Fifteen patients were infected by MDR-AB, of which 13 presented respiratory tract infection, one suffered deep surgical site infection and bacteraemia and one from catheter-related infection. They were all treated with intravenous and aerolized colistin in combination with rifampicin or ampicillin and sulbactam. Despite significant ' in vitro ' activity of colistin against this virulent organism and its acceptable safety profile, results were discouraging as only 13% survived. In fact, cure or clinical improvement was observed only in four patients (27%) while 11 patients (73%) developed sepsis and multiple organ failure. Scale 1 measures were implemented for the whole 12-month period while Scale 2 for two separate 3-week periods. Following this infection control strategy we achieved intermittent eradication of the pathogen during a 12-month period with continuous function of the SICU. Increasing prevalence of MDR-AB in ICU patients demands installation of strict screening and contact precautions. Due to significant mortality of MDR-AB-infected patients, additional measurements like geographic isolation of all positive cases, exclusive medical and nursing personnel, use of separate supplies and facilities and intense environmental surveillance is highly recommended.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".