The Benefit of Education and Appropriate Antibiotics Use to Reduce Multidrug-Resistant Acinetobacter baumanii in a University-Affiliated Intensive Care Unit in Indonesia


Acinetobacter baumanii is an opportunistic pathogen known to cause hospital acquired infection presenting with varying clinical feature from simply to much more severe manifestation. More importantly, widely improper and overuse of antibiotics consumption have caused an endemic of multidrug-resistant-Acinetobacter baumanii leading to prolonged hospital stay and poorer prognosis for intensive care patients. A descriptive study of pre- and post-education was conducted at an intensive care setting in Indonesia. The microbiology data were collected to evaluate the benefit of education on hand hygiene and management of antibiotic use to reduce the number of MDR-Acinetobacter baumanii infection. Based on the result of previous local susceptibility patterns, Cefoperazone/Sulbactam and Amikacin are favored as the empirical therapy. Chi-square analysis shows the significant reduction of Acinetobacter baumanii cases from 70.8% (17/24) to 38% (3/8) with P-value 0.006. Similarly, the susceptibility rate significantly increased, from 21% to 100% to Amikacin; from 5% to 89% to Piperacillin/Tazobactam, and from 42% to 89% to Meropenem. Education improving around hand hygiene, appropriate antibiotic prescribing following local hospital guidelines and the result of antibiotic susceptibility has been shown to reduce the transmission of MDR-Acinetobacter baumanii in the intensive care in our unit within this Indonesian hospital.

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Cucunawangsih, &. , Lukman, L. , Sariwijaya, R. , Wibowo, P. and Sungono, V. (2015) The Benefit of Education and Appropriate Antibiotics Use to Reduce Multidrug-Resistant Acinetobacter baumanii in a University-Affiliated Intensive Care Unit in Indonesia. Open Journal of Medical Microbiology, 5, 163-168. doi: 10.4236/ojmm.2015.54020.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Kyungwon, L., Dongeun, Y., Seok-Hoon, J. and Yunsop, C. (2011) Multidrug-Resistant Acinetobacter spp.: Increasingly Problematic Nosocomial Pathogens. Yonsei Medical Journal, 52, 879-891.
[2] Perween, N., Sehgal, S. and Prakash, K. (2014) Geographical Patterns in Antimicrobial Resistance of Acinetobacter in Clinical Isolates. Journal of Clinical and Diagnostic Research, 8, DC10-DC12.
[3] Wisplinghoff, H., Bischoff, T., Tallent, S.M., Seifert, H., Wenzel, R.P. and Edmond, M.B. (2004) Nosocomial Bloodstream Infections in US Hospitals: Analysis of 24,178 Cases from a Prospective Nation Wide Surveillance Study. Clinical Infectious Diseases, 39, 309-317.
[4] Rungruanghiranya, S., Somboonwit, C. and Kanchanapoom, T. (2005) Acinetobacter Infection in the Intensive Care Unit. Journal of Infectious Diseases and Antimicrobial Agents, 22, 77-88.
[5] Cerqueira, G.M. and Peleg, A.Y. (2011) Insights into Acinetobacter baumannii Pathogenicity, IUBMB Life, 63, 1055-1060.
[6] Peleg, A.Y., de Breij, A., Adams, M,D., Cerqueira, G.M., Mocali, S., Galardini, M., et al. (2012) The Success of Acinetobacter Species; Genetic, Metabolic, and Virulence Attributes. PLoS ONE, 7, e46984.
[7] Perez, F., Hujer, A.M., Hujer, K.M., Decker, B.K., Rather, P.N. and Bonomo, R.A. (2007) Global Challenge of Multidrug-Resistant Acinetobacter baumannii. Antimicrobial Agents and Chemotherapy, 51, 3471-3484.
[8] Fournier, P.E. and Richet, H. (2006) The Epidemiology and Control of Acinetobacter baumannii in Healthcare Facilities. Clinical Infectious Disease, 42, 692-699.
[9] Sureshg, J., Geetanjalim, L., Meenakshig, S., Nilimav, T., Vikrams, G. and Krishnab, N. (2006) Clinical and Demographic Features of Infection Cased by Acinetobacter Species. Indian Journal of Medical Sciences, 60, 351-360.
[10] Allegranzi, B., Bagheri, N.S., Combescure, C., Graafmans, W., Attar, H., Donaldson, L., et al. (2011) Burden of Endemic Health-Care-Associated Infection in Developing Countries: Systematic Review and Meta-Analysis. The Lancet, 377, 228-241.
[11] Clinical and Laboratory Standard Institute (2012) Performance Standards for Antimicrobial Susceptibility Testing, Twenty-Second Informational Supplement.
[12] Kunz, A.N. and Brook, I. (2010) Emerging Resistant Gram-Negative Aerobic Bacilli in Hospital-Aquired Infections. Chemotherapy, 56, 492-500.
[13] Cisneros, J.M. and Rodriguez-Bano, J. (2002) Nosocomial Bacteremia Due to Acinetobacter baumannii: Epidemiology, Elinical Features, and Treatment. Clinical Microbiology and Infection, 8, 687-693.
[14] Howard, A., Donoghue, M.O., Feeney, A. and Sleator, R.D. (2012) Acinetobacter baumannii: An Emerging Opportunistic Pathogen. Virulence, 3, 243-250.
[15] Dijkshoorn, L., Nemec, A. and Harald, S. (2007) An Increasing Threat in Hospitals: Multidrug-Resistant Acinetobacter baumannii. Nature Reviews Microbiology, 5, 939-949.
[16] Mortensen, B.L. and Skaar, E.P. (2012) Host-Microbe Interactions That Shape the Pathogenesis of Acinetobacter baumannii Infection. Cellular Microbiology, 14, 1336-1344.
[17] Gonlugur, U., Bakici, M.Z., Akkurt, I. and Efeoglu, T. (2004) Antibiotica Susceptibility Patterns among Respiratory Isolates of Gram-Negative Bacilli in a Turkish University Hospital. BMC Microbiology, 4, 32.
[18] Weisenberg, S.A., Schuetz, A.N., Alexander, E.A., Eiss, B., Behta, M., et al. (2011) Endemic Acinetobacter baumanii in a New York Hospital. PLoS ONE, 6, e28566.
[19] Dent, L.L., Marshal, D.R., Pratap, S. and Hulette, R.B. (2010) Multidrug Resistant Acinetobacter baumanii: A Descriptive Study in a City Hospital. BMC Infectious Diseases, 10, 196.
[20] Khan, M.A., Mahomed, M.F., Ashshi, A.M. and Faiz, A. (2012) Drug Resistance Patterns of Acinetobacter baumanii in Makkah, Saudi Arabia. Pakistan Journal of Medical Research, 51, 127-131.
[21] Hsueh, P.R., Teng, L.J., Chen, C.Y., Chen, W.H., Yu, C.J., et al. (2002) Pandrug-Resistant Acinetobacter baumanii Causing Nosocomial Infections in a University Hospital, Taiwan. Emerging Infectious Diseases, 8, 827-832.
[22] Maragakis, L.L. and Perl, T.M. (2008) Acinetobacter baumannii: Epidemiology, Antimicrobial Resistance, and Treatment Options. Clinical Infectious Diseases, 46, 1254-1263.
[23] Thuong, M., Shortgen, F., Zazempa, V., Girou, E., Soussy, C.J. and Brun-Buisson, C. (2000) Appropriate Use of Restricted Antimicrobial Agents in Hospitals the Importance of Empirical Therapy and Assisted Re-evaluation. Journal of Antimicrobial Chemotherapy, 46, 501-508.
[24] Goldman, D.A., Weinstein, R.A., Wenzel, R.P., Tablan, O.C., Duma, R.J., et al. (1996) Strategies to Prevent and Control the Emergence and Spread Antimicrobial-Resistant Microorganisms in Hospitals: A Challenge to Hospital Leadership. JAMA, 275, 234-240.
[25] Allegranzi, B. and Pittet, D. (2009) Role of Hand Hygiene in Health-Care-Associated Infection Prevention. The Journal of Hospital Infection, 73, 305-315.

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