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Extensively drug-resistant Acinetobacter baumannii outbreak cross-transmitted in an intensive care unit and respiratory intensive care unit

  • Author Footnotes
    1 J.L. and S.H. contributed equally to this work.
    Jin'e Lei
    Footnotes
    1 J.L. and S.H. contributed equally to this work.
    Affiliations
    Department of Pathogenic Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China

    Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, China

    Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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  • Author Footnotes
    1 J.L. and S.H. contributed equally to this work.
    Shaoshan Han
    Footnotes
    1 J.L. and S.H. contributed equally to this work.
    Affiliations
    Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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  • Wenjing Wu
    Affiliations
    Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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  • Xue Wang
    Affiliations
    Intensive Care Unit, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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  • Jiru Xu
    Affiliations
    Department of Pathogenic Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China

    Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, China
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  • Lei Han
    Correspondence
    Address correspondence to Lei Han, PhD, Department of Pathogenic Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, 76 W Yanta Rd, Xi'an 710061, China. (L. Han).
    Affiliations
    Department of Pathogenic Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China

    Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, China
    Search for articles by this author
  • Author Footnotes
    1 J.L. and S.H. contributed equally to this work.

      Highlights

      • We describe an extensively drug-resistant Acinetobacter baumannii outbreak cross-transmitted between an intensive care unit and respiratory intensive care unit.
      • The laminar flow system connecting the intensive care unit and respiratory intensive care unit was the source of transmission.
      • The outbreak terminated after thorough cleaning, including the laminar flow system.

      Background

      Extensively drug-resistant Acinetobacter baumannii (XDRAB) is a great threat in intensive care units (ICUs). The aim of this study was to describe an XDRAB outbreak which was cross-transmitted in the ICU and respiratory intensive care unit (RICU) in a tertiary care hospital from January-March 2013.

      Methods

      Patient and environmental surveillances were performed. Isolates were tested for antimicrobial susceptibility. Genotypes were analyzed by multilocus sequence typing (MLST). A series of enhanced strategies were implemented to control the outbreak.

      Results

      A total of 11 patients were infected by XDRAB strains during this outbreak. Three patients in the ICU were found positive for XDRAB at the onset of the outbreak. Thereafter, infections were detected in 6 patients in the RICU, followed by reappearance of this strain in the ICU in 2 patients. All A baumannii strains isolated from patients and the environment were extensively drug resistant. MLST revealed them as ST368. After 3 rounds of environmental screening and cleaning, the laminar flow system connecting the ICU and RICU was found as the source of transmission. Successful control of this outbreak was achieved through multifaceted intervention measures.

      Conclusions

      This study suggested the importance of thorough surveillance and disinfection of the environment, including concealed devices, in preventing the transmission of an outbreak.

      Key Words

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