How long should a patient with Acinetobacter baumannii infection be placed under isolation?

Isolation Duration for Acinetobacter baumannii Infection

Patients with Acinetobacter baumannii infection should be isolated for at least 2 weeks during antimicrobial therapy, especially for severe infections such as ventilator-associated pneumonia (VAP) or bacteremia, particularly in cases with severe sepsis or septic shock. 1

Isolation Requirements

• Patients diagnosed with A. baumannii infection should be placed in a single room with a self-contained toilet and dedicated hand basin 1
• Isolation should be maintained throughout the full course of effective antimicrobial therapy, which is recommended to be 2 weeks for severe infections 1
• Shorter isolation periods may be acceptable for less severe infections, but should be determined based on clinical improvement and infection site 1
• Notes and charts should be kept outside the room, and patients should have dedicated equipment where possible 1

Infection Control Measures During Isolation

• Healthcare workers must use personal protective equipment (PPE) including disposable gloves and aprons when in contact with the patient, their equipment, or immediate surroundings 1
• Facial protection (fluid-repellent surgical mask and eye shield/visor) is recommended when there is risk of transmission from droplets, such as during bronchoscopy or suctioning 1
• Strict hand hygiene must be practiced by healthcare workers before and after patient contact, regardless of glove use 1
• Environmental cleaning of the isolation room, furniture, and equipment must be performed daily at minimum, with terminal cleaning upon patient discharge 1

Special Considerations

• For patients with A. baumannii pulmonary infections, nebulized antibiotics (particularly colistin) may be considered as adjunctive therapy, which can increase cure rates 1
• The recommended dose of nebulized colistin is 2 million IU every 8 or 12 hours, although higher doses can be used in non-resolving cases 1
• Patients should not be moved from isolation for non-clinical reasons; if transport is necessary (e.g., for medical procedures), the patient should wear appropriate protection 1

Determining End of Isolation

• Isolation should continue for the full duration of antimicrobial therapy (typically 2 weeks for severe infections) 1
• Clinical improvement, including decreased cough and reduction in the number of organisms on sequential cultures, should be observed before discontinuing isolation 1
• The risk of transmission remains significant throughout treatment due to A. baumannii's ability to persist in the environment and cause outbreaks 2, 3

Impact of Proper Isolation Practices

• Failure to implement appropriate isolation measures can lead to increased incidence of A. baumannii infections throughout the hospital 3
• Proper isolation and infection control measures have been shown to successfully control outbreaks without requiring unit closure 2
• A. baumannii acquisition is associated with severe adverse outcomes, including increased mortality, need for mechanical ventilation, and reduced functional status at discharge, highlighting the importance of effective isolation 4

Common Pitfalls to Avoid

• Premature discontinuation of isolation before completion of antimicrobial therapy can lead to ongoing transmission 3
• Treating colonization rather than true infection can lead to unnecessary antibiotic use and decreased susceptibility of other pathogens like Pseudomonas aeruginosa 5
• Failure to distinguish between colonization and infection may result in inappropriate management; approximately 60% of patients with positive A. baumannii cultures may be colonized rather than infected 6
• Inadequate environmental cleaning can allow A. baumannii to persist and cause ongoing transmission despite other control measures 1