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Nosocomial Outbreak of Infection With Pan–Drug-Resistant Acinetobacter baumannii in a Tertiary Care University Hospital

Published online by Cambridge University Press:  02 January 2015

Raquel Valencia ,
Luis A. Arroyo ,
Manuel Conde ,
Josefa M. Aldana ,
María-José Torres ,
Felipe Fernández-Cuenca ,
José Garnacho-Montero ,
José M. Cisneros ,
Carlos Ortiz  and
Jerónimo Pachón
...Show all authors
Raquel Valencia*
Affiliation:
Preventive Medicine and Public Health Service, Virgen del Rocío University Hospitals, Spain Departments of Preventive Medicine, the University of Seville, Spain
Luis A. Arroyo
Affiliation:
Clinical Microbiology Service, Virgen del Rocío University Hospitals, Spain
Manuel Conde
Affiliation:
Preventive Medicine and Public Health Service, Virgen del Rocío University Hospitals, Spain Departments of Preventive Medicine, the University of Seville, Spain
Josefa M. Aldana
Affiliation:
Preventive Medicine and Public Health Service, Virgen del Rocío University Hospitals, Spain
María-José Torres
Affiliation:
Microbiology, the University of Seville, Spain
Felipe Fernández-Cuenca
Affiliation:
Microbiology, the University of Seville, Spain
José Garnacho-Montero
Affiliation:
Intensive Care Service, Virgen del Rocío University Hospitals, Spain
José M. Cisneros
Affiliation:
Infectious Diseases Service, Virgen del Rocío University Hospitals, Spain
Carlos Ortiz
Affiliation:
Intensive Care Service, Virgen del Rocío University Hospitals, Spain
Jerónimo Pachón
Affiliation:
Infectious Diseases Service, Virgen del Rocío University Hospitals, Spain Medicine, the University of Seville, Spain
Javier Aznar
Affiliation:
Clinical Microbiology Service, Virgen del Rocío University Hospitals, Spain Microbiology, the University of Seville, Spain
*
Preventive Medicine and Public Health Services, Virgen del Rocío Hospital, Avenida Manuel Siurot s/n, Seville 41013, Spain(raquel.valencia.sspa@juntadeandalucia.es)
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Abstract

Objective.

TO describe what is, to our knowledge, the first nosocomial outbreak of infection with pan–drug-resistant (including colistin-resistant) Acinetobacter baumannii, to determine the risk factors associated with these types of infections, and to determine their clinical impact.

Design.

Nested case-control cohort study and a clinical-microbiological study.

Setting.

A 1,521-bed tertiary care university hospital in Seville, Spain.

Patients.

Case patients were inpatients who had a pan-drug-resistant A. baumannii isolate recovered from a clinical or surveillance sample obtained at least 48 hours after admission to an intensive care unit (ICU) during the time of the epidemic outbreak. Control patients were patients who were admitted to any of the “boxes” (ie, rooms that partition off a distinct area for a patient's bed and the equipment needed to care for the patient) of an ICU for at least 48 hours during the time of the epidemic outbreak.

Results.

All the clinical isolates had similar antibiotic susceptibility patterns (ie, they were resistant to all the antibiotics tested, including Colistin), and, on the basis of repetitive extragenic palindromic-polymerase chain reaction, it was determined that all of them were of the same clone. The previous use of quinolones and glycopeptides and an ICU stay were associated with the acquisition of infection or colonization with pan-drug-resistant A. baumannii. To control this outbreak, we implemented the following multicomponent intervention program: the performance of environmental decontamination of the ICUs involved, an environmental survey, a revision of cleaning protocols, active surveillance for colonization with pan-drug-resistant A. baumannii, educational programs for the staff, and the display of posters that illustrate contact isolation measures and antimicrobial use recommendations.

Conclusions.

We were not able to identify the common source for these cases of infection, but the adopted measures have proven to be effective at controlling the outbreak.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 3 , March 2009 , pp. 257 - 263
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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