Prevalence and risk factors for carriage of carbapenem-resistant Acinetobacter baumannii in post-acute care hospitals, Israel, 2021.

Abstract

BackgroundPost-acute care hospitals (PACH) may act as regional reservoirs for multidrug-resistant organisms.AimWe aimed to investigate the prevalence of carbapenem-resistant Acinetobacter baumannii (CRAB) carriers and identify risk factors for CRAB carriage in PACH.MethodsWe conducted a point prevalence survey in 18 PACH in Israel from June to December 2021. We screened patients in 55 wards of four types (mechanical ventilation, skilled nursing, sub-acute and rehabilitation) for CRAB carriage from skin, rectum and tracheostomy secretions (if applicable). We collected data on patient characteristics (including prior CRAB carriage) and ward and institution characteristics. We calculated the prevalence of CRAB carriers, the percentage of newly detected carriers, and assessed predictors of CRAB carriage using a mixed-effects logistic regression model.ResultsWe screened 1,725 patients, with 385 (22%) testing positive for CRAB. The median prevalence of CRAB carriers was 48% (interquartile range (IQR): 33-70) in ventilation wards, 28% (IQR: 18-46) in skilled nursing wards, 8% (IQR: 6-13) in sub-acute wards and 0% (IQR: 0-3) in rehabilitation wards. Only 31% (118/385) had a known history of CRAB carriage. Individual risk factors for CRAB positivity included known CRAB carriage, bedsores and presence of a feeding tube. Modifiable ward-level risk factors included poor availability of alcohol-based hand rub (adjusted odds ratio (aOR) = 3.22; 95% confidence interval (CI): 1.52-6.81) and suctioning in common areas (aOR = 2.23; 95% CI: 1.30-3.85).ConclusionsThe hidden reservoir of CRAB carriers in Israeli ventilation and skilled nursing wards is large. We identified modifiable risk factors at ward level, highlighting areas for targeted intervention.