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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Infection ControlAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Current control and treatment of multidrug-resistant Acinetobacter baumannii infections.Lancet Infect Dis. 2008; 8: 751-762
- Acinetobacter baumannii: emergence of a successful pathogen.Clin Microbiol Rev. 2008; 21: 538-582
- First report of an OXA-23 carbapenemase-producing Acinetobacter baumannii clinical isolate related to Tn2006 in Spain.Antimicrob Agents Chemother. 2013; 57: 589-591
- Spread of multidrug carbapenem-resistant Acinetobacter baumannii in different wards of an Italian hospital.Am J Infect Control. 2011; 39: 790-794
- Outbreak of carbapenem-resistant Acinetobacter baumannii carrying the carbapenemase OXA-23 in a German university medical centre.J Med Microbiol. 2009; 58: 1499-1507
- Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance.Clin Microbiol Infect. 2012; 18: 268-281
- A PCR-based method to differentiate between Acinetobacter baumannii and Acinetobacter genomic species 13TU.Clin Microbiol Infect. 2007; 13: 1199-1201
- Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; approved standard-ninth edition (M07-A9).CLSI, Wayne (PA)2012
- Non-susceptibility trends among Pseudomonas aeruginosa and other non-fermentative Gram-negative bacteria from bacteraemias in the UK and Ireland, 2001-06.J Antimicrob Chemother. 2008; 62: ii55-63
- Antimicrobial resistance in Europe and its potential impact on empirical therapy.Clin Microbiol Infect. 2008; 14: 2-8
- Multidrug-resistant Acinetobacter baumannii in New York City—10 years into the epidemic.Infect Control Hosp Epidemiol. 2009; 30: 196-197
- Outbreak of extensively drug-resistant Acinetobacter baumannii indigo-pigmented strains.J Clin Microbiol. 2013; 51: 3726-3730
- Clonal spread and patient risk factors for acquisition of extensively drug-resistant Acinetobacter baumannii in a neonatal intensive care unit in Italy.J Hosp Infect. 2012; 82: 260-265
- Treatment options for carbapenem-resistant and extensively drug-resistant Acinetobacter baumannii infections.Drugs. 2014; 74: 1315-1333
- The Acinetobacter baumannii oxymoron: commensal hospital dweller turned pan-drug-resistant menace.Front Microbiol. 2012; 3: 148
- Multidrug resistant Acinetobacter.J Glob Infect Dis. 2010; 2: 291-304
- A gloves-associated outbreak of imipenem-resistant Acinetobacter baumannii in an intensive care unit in Guangdong, China.BMC Infect Dis. 2015; 15: 179
- Activities of colistin- and minocycline-based combinations against extensive drug resistant Acinetobacter baumannii isolates from intensive care unit patients.BMC Infect Dis. 2011; 11: 109
- In vitro activity of teicoplanin combined with colistin versus multidrug-resistant strains of Acinetobacter baumannii.J Antimicrob Chemother. 2011; 66: 1047-1051
- Potent synergy and sustained bactericidal activity of a vancomycin-colistin combination versus multidrug-resistant strains of Acinetobacter baumannii.Antimicrob Agents Chemother. 2010; 54: 5316-5322
- In vitro activity of tigecycline in combination with various antimicrobials against multidrug resistant Acinetobacter baumannii.Ann Clin Microbiol Antimicrob. 2009; 8: 18
- Postantibiotic effects of tigecycline, colistin sulfate, and levofloxacin alone or tigecycline-colistin sulfate and tigecycline-levofloxacin combinations against Acinetobacter baumannii.Chemotherapy. 2010; 56: 466-471
- In vitro synergy of colistin combinations against extensively drug-resistant Acinetobacter baumannii producing OXA-23 carbapenemase.J Chemother. 2016; (in press)https://doi.org/10.1179/1973947815Y.0000000030
- Risk factors of multidrug-resistant, extensively drug-resistant and pandrug-resistant Acinetobacter baumannii ventilator-associated pneumonia in a medical intensive care unit of university hospital in Thailand.J Infect Chemother. 2015; 21: 570-574
- Higher incidence of acute kidney injury with intravenous colistimethate sodium compared with polymyxin B in critically ill patients at a tertiary care medical center.Clin Infect Dis. 2013; 57: 1300-1303
- Cross-transmission of multidrug-resistant Acinetobacter baumannii clonal strains causing episodes of sepsis in a trauma intensive care unit.Infect Control Hosp Epidemiol. 2008; 29: 410-417
Article info
Publication history
Published online: May 20, 2016
Footnotes
Funding/Support: This work was supported by the Research Fund of Xi'an Jiaotong University (DW081135K0000004).
Conflicts of Interest: None to report.
Identification
Copyright
© 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
