AJIC: American Journal of Infection Control
Volume 37, Issue 9 , Pages 715-722 , November 2009

Long-term control of hospital-wide, endemic multidrug-resistant Acinetobacter baumannii through a comprehensive “bundle” approach

  • Jesús Rodríguez-Baño, MD, PhD

      Affiliations

    • Sección Enfermedades Infecciosas, Hospital Universitario Virgen Macarena and Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
    • ,
  • Lola García, RN

      Affiliations

    • Sección Enfermedades Infecciosas, Hospital Universitario Virgen Macarena and Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
    • ,
  • Encarnación Ramírez, MD, PhD

      Affiliations

    • Servicio de Microbiología, Hospital Universitario Virgen Macarena, and Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
    • ,
  • Luis Martínez-Martínez, MD, PhD

      Affiliations

    • Servicio de Microbiología, Hospital Universitario Virgen Macarena, and Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
    • ,
  • Miguel A. Muniain, MD, PhD

      Affiliations

    • Sección Enfermedades Infecciosas, Hospital Universitario Virgen Macarena and Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
    • ,
  • Felipe Fernández-Cuenca, MD, PhD

      Affiliations

    • Servicio de Microbiología, Hospital Universitario Virgen Macarena, and Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
    • ,
  • Margarita Beltrán, PhD

      Affiliations

    • Servicio de Farmacia, Hospital Universitario Virgen Macarena, Sevilla, Spain
    • ,
  • Juan Gálvez, MD

      Affiliations

    • Sección Enfermedades Infecciosas, Hospital Universitario Virgen Macarena and Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
    • ,
  • Jose M. Rodríguez, PhD

      Affiliations

    • Servicio de Microbiología, Hospital Universitario Virgen Macarena, and Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
    • ,
  • Carmen Velasco, PhD

      Affiliations

    • Servicio de Microbiología, Hospital Universitario Virgen Macarena, and Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
    • ,
  • Concepción Morillo, RN

      Affiliations

    • Servicio de Microbiología, Hospital Universitario Virgen Macarena, and Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
    • ,
  • Federico Perez, MD

      Affiliations

    • Case Western Reserve University, School of Medicine, Louis Stokes Veteran Affairs Medical Center, Cleveland, OH
    • ,
  • Andrea Endimiani, MD, PhD

      Affiliations

    • Case Western Reserve University, School of Medicine, Louis Stokes Veteran Affairs Medical Center, Cleveland, OH
    • ,
  • Robert A. Bonomo, MD

      Affiliations

    • Case Western Reserve University, School of Medicine, Louis Stokes Veteran Affairs Medical Center, Cleveland, OH
    • Corresponding Author InformationAddress correspondence to Robert A. Bonomo, MD, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH, 44106.
    • ,
  • Alvaro Pascual, MD, PhD

      Affiliations

    • Servicio de Microbiología, Hospital Universitario Virgen Macarena, and Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain

References 

  1. Gaynes R, Edwards JR. and the National Nosocomial Infections Surveillance System. Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis. 2005;41:848–854
  2. Davis KA, Moran KA, McAllister CK, Gray PJ. Multidrug-resistant Acinetobacter extremity infections in soldiers. Emerg Infect Dis. 2005;11:1218–1224
  3. Rodríguez-Baño J, Cisneros JM, Fernández-Cuenca F, Ribera A, Vila J, Pascual A, et al. Clinical features and epidemiology of Acinetobacter baumannii colonization and infection in Spanish hospitals. Infect Control Hosp Epidemiol. 2004;25:819–824
  4. Alvarez-Lerma F, Palomar M, Olaechea P, Insausti J, Bermejo B. Cerda E y Grupo de estudio de vigilancia de infección nosocomial en UCI. Estudio Nacional de vigilancia de infección nosocomial en unidades de cuidados intensivos. Informe del año 2001. Med Intensiva. 2003;27:13–23
  5. Bergogne-Bérézin E, Towner KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microb Rev. 1996;9:148–165
  6. Garcia-Garmendia JL, Ortiz-Leyba C, Garnacho-Montero J, Jimenez-Jimenez FJ, Monterrubio-Villar J, Gili-Miner M. Mortality and the increase in length of stay attributable to the acquisition of Acinetobacter in critically ill patients. Crit Care Med. 1999;27:1794–1799
  7. Wilson SJ, Knipe CJ, Zieger MJ, Gabehart KM, Goodman JE, Volk HM, et al. Direct costs of multidrug-resistant Acinetobacter baumannii in the burn unit of a public teaching hospital. Am J Infect Control. 2004;32:342–344
  8. Afzal-Shah M, Livermore DM. Worldwide emergence of carbapenem-resistant Acinetobacter spp. J Antimicrob Chemother. 1998;41:576–577
  9. Landman D, Quale JM, Mayorga D, Adedeji A, Vangala K, Ravishankar J, et al. Citywide clonal outbreak of multiresistant Acinetobacter baumannii and Pseudomonas aeruginosa in Brooklyn, NY: the preantibiotic era has returned. Arch Intern Med. 2002;162:1515–1520
  10. Villegas MV, Harstein AI. Acinetobacter outbreaks, 1977-2000. Infect Control Hosp Epidemiol. 2003;24:284–295
  11. Villers D, Espaze E, Coste-Burel M, Giauffret F, Ninin E, Nicolas F, et al. Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med. 1998;129:182–189
  12. Corbella X, Montero A, Pujol M, Domínguez MA, Ayats J, Argerich MJ, et al. Emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multiresistant Acinetobacter baumannii. J Clin Microbiol. 2000;38:4086–4095
  13. Urban C, Segal-Maurer S, Rahal J. Considerations in control and treatment of nosocomial infections due to multidrug-resistant Acinetobacter baumannii. Clin Infect Dis. 2003;36:1268–1274
  14. Abbo A, Navon-Venezia S, Hammer-Muntz O, Krichali T, Siegman-Igra Y, Carmeli Y. Multidrug-resistant Acinetobacter baumannii. Emerg Infect Dis. 2005;11:22–29
  15. Rodríguez-Baño J. Nosocomial bacteraemia due to Acinetobacter baumannii. Rev Med Microbiol. 1999;10:67–78
  16. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. Am J Infect Control. 1988;16:128–140
  17. Vaqué J, Rosello J, Arribas JL. Prevalence of nosocomial infections in Spain: EPINE study 1990-1997. EPINE Working group. J Hosp Infect. 1999;43(Suppl):S105–S111
  18. Rodríguez-Baño J, Pascual A, Gálvez J, Muniain MA, Ríos MJ, Martínez-Martínez L, et al. Bacteriemias por Acinetobacter baumannii: características clínicas y pronósticas. Enferm Infecc Microbiol Clin. 2003;21:242–246
  19. Rodríguez Baño J, Ramírez E, Santos J, Martinez-Martinez L, Munian MA, Joyanes P, et al. Risk factors for colonization with Acinetobacter baumannii in the intensive care unit (abstract J-203). Abstracts of the 37th Interscience Conference on Antimicrobial Agents and Chemotherapy (Toronto, Canada). Washington, DC: American Society for Microbiology; 1997. p. 326.
  20. Centers for Disease Control and Prevention . Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR. 2003;52(No. RR-10):1–48
  21. Bouvet PJM, Grimont PAD. Taxonomy of the genus Acinetobacter with recognition of Acinetobacter baumannii sp. nov., Acinetobacter haemolyticus sp. nov., Acinetobacter johnsonii sp. nov., and Acinetobacter junii sp. nov. and emended descriptions of Acinetobacter calcoaceticus and Acinetobacter lwoffi. Int J Syst Bacteriol. 1986;36:228–240
  22. Allardet-Servent A, Bouziges N, Carles-Nurit MJ, Bourg G, Gouby A, Ramuz M. Use of low-frequency-cleavage restriction endonucleases for DNA analysis in epidemiological investigations of nosocomial infections. J Clin Microbiol. 1989;27:2057–2061
  23. Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, et al. Interpreting chromosomal DNA restriction patterns by pulsed-field gel electrophoresis; criteria for bacteria strain typing. J Clin Microbiol. 1995;33:2233–2239
  24. Vaneechoutte M, Dijkshoorn L, Tjernberg I, Elaichouni A, de Vos P, Claeys G, et al. Identification of Acinetobacter genomic species by amplified ribosomal DNA restriction analysis. J Clin Microbiol. 1995;33:11–15
  25. Roberts SA, Findlay R, Lang SD. Investigation of an outbreak of multi-drug resistant Acinetobacter baumannii in an intensive care burns unit. J Hosp Infect. 2001;48:228–232
  26. Corbella X, Pujol M, Argerich MJ, Ayats J, Sendra M, Peña C, et al. Environmental sampling of Acinetobacter baumannii: moistened swabs versus moistened sterile gauze pads. Infect Control Hosp Epidemiol. 1999;20:458–460
  27. Go S, Urban C, Burns J, Kreiswirth B, Eisner W, Mariano N, et al. Clinical and molecular epidemiology of Acinetobacter infections sensitive only to polymyxin B and sulbactam. Lancet. 1994;344:1329–1332
  28. Mulin B, Talon D, Viel JF, Vincent C, Leprat R, Thouverez M, et al. Risk factors for nosocomial colonization with multiresistant Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis. 1995;14:569–576
  29. Ayan M, Durmaz R, Aktas E, Durmaz B. Bacteriological, clinical and epidemiological characteristics of hospital acquired Acinetobacter baumannii in a teaching hospital. J Hosp Infect. 2003;54:39–45
  30. Apisarnthanarak A, Pinitchai U, Thongphubeth K, Yuekyen C, Warren DK, Fraser VJ. for the Thammasat University Pandrug-Resistant Acinetobacter baumannii Control Group. A multifaceted intervention to reduce pandrug-resistant Acinetobacter baumannii colonization and infection in 3 intensive care units in a Thai tertiary care center: a 3-year study. Clin Infect Dis. 2008;47:760–767
  31. Sunenshine RH, Liedtke L, Fridkin SK, Strausbaugh LJ. the Infectious Diseases Society of America Emerging Infections Network. Management of inpatients colonized or infected with antimicrobial-resistant bacteria in hospitals in the United States. Infect Control Hosp Epidemiol. 2005;26:138–143
  32. Villari P, Iacuzio L, Vozzella EA, Bosco U. Unusual genetic heterogeneity of Acinetobacter baumannii isolates in a university hospital in Italy. Am J Infect Control. 1999;27:247–253
  33. Harris AD, Bradham DD, Baumgarten M, Zuckerman IH, Fink JC, Perencevich EN. The use and interpretation of quasi-experimental studies in infectious diseases. Clin Infect Dis. 2004;38:1586–1591
  34. Corbella X, Pujol M, Ayats J, Sendra M, Ardanuy C, Domínguez MA, et al. Relevance of digestive tract colonization in the epidemiology of nosocomial infections due to multiresistant Acinetobacter baumannii. Clin Infect Dis. 1996;23:329–334
  35. Wendt C, Dietetze B, Dietez E, Riiden H. Survival of Acinetobacter baumannii on dry surfaces. J Clin Microbiol. 1997;35:1394–1397
  36. Webster CA, Crowe M, Humphreys H, Towner KJ. Surveillance of an adult intensive care unit for long-term persistence of a multiresistant strain of Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis. 1998;17:171–176
  37. D'Agata EMC, Thayer V, Shaffner W. An outbreak of Acinetobacter baumannii: the importance of cross-transmission. Infect Control Hosp Epidemiol. 2000;21:588–591

 L.M-M.'s present address is Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.

 Supported in part by the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III-FEDER, Spanish Network for the Research in Infectious Diseases (REIPI C03/14 and REIPI RD06/0008), and FIS PI051019; a fellowship from the Asociación Sanitaria Virgen Macarena (to C.M.); the Merit Review Award and Geriatric Research Education and Clinical Center VISN 10 from the Department of Veterans Affairs and the NIH (RO1 AI072219; to R.A.B.); AstraZeneca (to A.E.); and a Wyeth Fellowship in Antimicrobial Resistance (to F.P.).

 Conflicts of interest: None to report.

PII: S0196-6553(09)00106-0

doi: 10.1016/j.ajic.2009.01.008

AJIC: American Journal of Infection Control
Volume 37, Issue 9 , Pages 715-722 , November 2009

Article Tools

* Image Usage & Resolution