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An Outbreak Due to Multiresistant Acinetobacter baumannii in a Burn Unit: Risk Factors for Acquisition and Management

Published online by Cambridge University Press:  02 January 2015

Andrew E. Simor ,
Mark Lee ,
Mary Vearncombe ,
Linda Jones-Paul ,
Clare Barry ,
Manuel Gomez ,
Joel S. Fish ,
Robert C. Cartotto ,
Robert Palmer  and
Marie Louie
Andrew E. Simor*
Affiliation:
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, North York University of Toronto, Toronto, Ontario, Canada
Mark Lee
Affiliation:
University of Toronto, Toronto, Ontario, Canada
Mary Vearncombe
Affiliation:
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, North York University of Toronto, Toronto, Ontario, Canada
Linda Jones-Paul
Affiliation:
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, North York
Clare Barry
Affiliation:
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, North York
Manuel Gomez
Affiliation:
Department of Surgery, Sunnybrook and Women's College Health Sciences Centre, North York University of Toronto, Toronto, Ontario, Canada
Joel S. Fish
Affiliation:
Department of Surgery, Sunnybrook and Women's College Health Sciences Centre, North York University of Toronto, Toronto, Ontario, Canada
Robert C. Cartotto
Affiliation:
Department of Surgery, Sunnybrook and Women's College Health Sciences Centre, North York
Robert Palmer
Affiliation:
University of Toronto, Toronto, Ontario, Canada
Marie Louie
Affiliation:
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, North York University of Toronto, Toronto, Ontario, Canada
*
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, B121-2075 Bayview Avenue, North York, Ontario, CanadaM4N 3M5
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Abstract

Objectives:

To describe the investigation and management of an outbreak due to multiresistant Acinetobacter baumannii and to determine risk factors for acquisition of the organism.

Setting:

A 14-bed regional burn unit in a Canadian tertiary-care teaching hospital.

Design:

Case-control study with multivariate analysis of potential risk factors using logistic regression analysis. Surveillance cultures were obtained from the hospital environment, from noninfected patients, and from healthcare providers.

Results:

A total of 31 (13%) of 247 patients with acute burn injuries acquired multiresistant A. baumannii between December 1998 and March 2000; 18 (58%) of the patients were infected. The organism was recovered from the hospital environment and the hands of healthcare providers. Significant risk factors for acquisition of multiresistant A. baumannii were receipt of blood products (odds ratio [OR], 10.8; 95% confidence interval [CI95], 3.4 to 34.4; P < .001); procedures performed in the hydrotherapy room (OR, 4.1; CI95, 1.3 to 13.1; P = .02); and increased duration of mechanical ventilation (OR, 1.1 per day; CI95, 1.0 to 1.1; P=. 02).

Interventions:

Improved compliance with hand hygiene, strict patient isolation, meticulous environmental cleaning, and temporary closure of the unit to new admissions.

Conclusions:

Acquisition of multiresistant A. baumannii was likely multifactorial, related to environmental contamination and contact with transiently colonized healthcare providers. Control measures addressing these potential sources of multiresistant A. baumannii were successful in terminating the outbreak. Ongoing surveillance and continued attention to hand hygiene and adequate environmental cleaning are essential to prevent recurrent outbreaks due to antibiotic-resistant bacteria in burn units.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 5 , May 2002 , pp. 261 - 267
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.Bergogne-Bérézin, E, Towner, KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996;9:148–165.CrossRefGoogle ScholarPubMed
2.McDonald, LC, Banerjee, SN, Jarvis, WR, National Nosocomial Infections Surveillance System. Seasonal variation of Acinetobacter infections: 1987-1996. Clin Infect Dis 1999;29:1133–1137.CrossRefGoogle ScholarPubMed
3.Beck-Sagué, C, Jarvis, WR, Brook, JH, et al. Epidemic bacteremia due to Acinetobacter baumannii in five intensive care units. Am J Epidemiol 1990;132:723–733.Google Scholar
4.Patterson, JE, Vecchio, J, Pantelick, EL, et al. Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit. Am J Med 1991;91:479–483.Google Scholar
5.Lortholary, O, Fagon, J-Y, Hoi, AB, et al. Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis. Clin Infect Dis 1995;20:790–796.Google Scholar
6.Kaul, R, Burt, J, Cork, L, et al. Investigation of a multiyear multiple critical care unit outbreak due to relatively drug-sensitive Acinetobacter baumannii: risk factors and attributable mortality. J Infect Dis 1996;174:1279–1287.CrossRefGoogle ScholarPubMed
7.D'Agata, EMC, Thayer, V, Schaffner, W. An outbreak of Acinetobacter baumannii: the importance of cross-transmission. Infect Control Hosp Epidemiol 2000;21:588–591.CrossRefGoogle ScholarPubMed
8.Okpara, AU, Maswoswe, JJ. Emergence of multidrug-resistant isolates of Acinetobacter baumannii. American Journal of Hospital Pharmacy 1994;51:2671–2675.Google ScholarPubMed
9.Go, ES, Urban, C, Burns, J, et al. Clinical and molecular epidemiology of Acinetobacter infections sensitive only to polymyxin B and sulbactam. Lancet 1994;344:1329–1332.CrossRefGoogle ScholarPubMed
10.Lyytikänen, O, Köljalg, S, Harmä, M, Vuopio-Varkila, J. Outbreak caused by two multi-resistant Acinetobacter baumannii clones in a burns unit: emergence of resistance to imipenem. J Hosp Infect 1995;31:41–54.CrossRefGoogle Scholar
11.Mulin, B, Talon, D, Viel, JF, et al. Risk factors for nosocomial colonization with multiresistant Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis 1995;14:569–576.CrossRefGoogle ScholarPubMed
12.Fierobe, L, Lucet, J-C, Deere, D, et al. An outbreak of imipenem-resistant Acinetobacter baumannii in critically ill surgical patients. Infect Control Hosp Epidemiol 2001;22:35–40.Google Scholar
13.Villers, D, Espaze, E, Coste-Burel, M, et al. Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med 1998;129:182–189.CrossRefGoogle ScholarPubMed
14.Husni, RN, Goldstein, LS, Arroliga, AC, et al. Risk factors for an outbreak of multi-drug-resistant Acinetobacter nosocomial pneumonia among intubated patients. Chest 1999;115:1378–1382.Google Scholar
15.Hartstein, AI, Rashad, AL, Liebler, JM, et al. Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contaminated, reusable ventilator circuits and resuscitation bags. Am J Med 1988;85:624–631.CrossRefGoogle ScholarPubMed
16.Vandenbroucke-Grauls, CMJE, Kerver, AJH, Rommes, JH, Jansen, R, den Dekker, C, Verhoef, J. Endemic Acinetobacter anitratus in a surgical intensive care unit: mechanical ventilators as reservoir. Eur J Clin Microbiol Infect Dis 1988;7:485–489.Google Scholar
17.Contant, J, Kemeny, E, Oxley, C, Perry, E, Garber, G. Investigation of an outbreak of Acinetobacter calcoaceticus var. anitratus infections in an adult intensive care unit. Am J Infect Control 1990;18:288–291.Google Scholar
18.Cefai, C, Richards, J, Gould, FK, McPeake, P. An outbreak of Acinetobacter respiratory tract infection resulting from incomplete disinfection of ventilatory equipment. J Hosp Infect 1990;15:177–182.CrossRefGoogle ScholarPubMed
19.Crowe, M, Towner, KJ, Humphreys, H. Clinical and epidemiological features of an outbreak of Acinetobacter infection in an intensive therapy unit. J Med Microbiol 1995;43:55–62.Google Scholar
20.Catalano, M, Quelle, LS, Jeric, PE, Di Martino, AMaimone, SM. Survival of Acinetobacter baumannii on bed rails during an outbreak and during sporadic cases. J Hosp Infect 1999;42:27–35.Google Scholar
21.Sheretz, RJ, Sullivan, ML. An outbreak of infections with Acinetobacter calcoaceticus in burn patients: contamination of patients' mattresses. J Infect Dis 1985;151:252–258.Google Scholar
22.Neely, AN, Maley, MP, Warden, GD. Computer keyboards as reservoirs for Acinetobacter baumannii in a burn hospital. Clin Infect Dis 1999; 29:1358–1359.Google Scholar
23.Green, AR, Milling, MAP. Infection with Acinetobacter in a burns unit. Burns 1983;9:292–294.Google Scholar
24.Wisplinghoff, H, Perbix, W, Seifert, H. Risk factors for nosocomial bloodstream infections due to Acinetobacter baumannii: a case-control study of adult burn patients. Clin Infect Dis 1999;28:59–66.Google Scholar
25.Seifert, H, Gerner-Smidt, P. Comparison of ribotyping and pulsed-field gel electrophoresis for molecular typing of Acinetobacter isolates. J Clin Microbiol 1995;33:1402–1407.CrossRefGoogle ScholarPubMed
26.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
27.Gomez, M, Stewart, G, Peters, W, et al. Improved prediction of mortality in burn patients. Clin Invest Med 1996;19:S13. Abstract 87.Google Scholar
28.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
29.Wurtz, R, Karajovic, M, Dacumos, E, Jovanovic, B, Hanumadass, M. Nosocomial infections in a burn intensive care unit. Burns 1995;21:181–184.CrossRefGoogle Scholar
30.Brigham, PA, McLoughlin, E. Burn incidence and medical care use in the United States: estimates, trends, and data sources. J Burn Care Rehabil 1996;17:95–107.Google Scholar
31.Weber, JM, Sheridan, RL, Pasternak, MS, Tompkins, RG. Nosocomial infections in pediatric patients with burns. Am J Infect Control 1997; 25:195–201.Google Scholar
32.Frame, JD, Kangesu, L, Malik, WM. Changing flora in burn and trauma units: experience in the United Kingdom. J Burn Care Rehabil 1992; 13:281–286.CrossRefGoogle ScholarPubMed
33.Lesseva, M. Central venous catheter-related bacteraemia in burn patients. Scand J Infect Dis 1998;30:585–589.Google Scholar
34.Rosenthal, SL. Sources of Pseudomonas and Acinetobacter species found in human culture materials. Am J Clin Pathol 1974;62:807–811.Google Scholar
35.Smith, PW, Massanari, RM. Room humidifiers as the source of Acinetobacter infections. JAMA 1977;237:795–797.Google Scholar
36.Gervich, DH, Grout, CS. An outbreak of nosocomial Acinetobacter infections from humidifiers. Am J Infect Control 1985;13:210–215.CrossRefGoogle ScholarPubMed
37.Weernink, A, Severin, WPJ, Tjernberg, I, Dijkshoorn, L. Pillows, an unexpected source of Acinetobacter. J Hosp Infect 1995;29:189–199.Google Scholar
38.Allen, KD, Green, HT. Hospital outbreak of multi-resistant Acinetobacter anitratus: an airborne mode of spread? J Hosp Infect 1987;9:110–119.CrossRefGoogle ScholarPubMed
39.Bernards, AT, Frénay, HME, Um, BT, Hendriks, WDH, Dijkshoorn, L, van Boven, CPA. Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii: an unexpected difference in epidemiologic behavior. Am J Infect Control 1998;26:544–551.Google Scholar
40.Getchell-White, SI, Donowitz, LG, Gröschel, DHM. The inanimate environment of an intensive care unit as a potential source of nosocomial bacteria: evidence for long survival of Acinetobacter calcoaceticus. Infect Control Hosp Epidemiol 1989;10:402–407.Google Scholar
41.Shankowsky, HA, Callioux, LS, Tredget, EE. North American survey of hydrotherapy in modern burn care. J Burn Care Rehabil 1994;15:143–146.Google Scholar
42.Tredget, EE, Shankowsky, HA, Joffe, AM, et al. Epidemiology of infections with Pseudomonas aeruginosa in burn patients: the role of hydrotherapy. Clin Infect Dis 1992;15:941–949.Google Scholar
43.Peacock, JE Jr, Sorrell, L, Sottile, FD, Price, LE, Rutala, WA. Nosocomial respiratory tract colonization and infection with aminoglycoside-resistant Acinetobacter calcoaceticus var anitratus: epidemiologic characteristics and clinical significance. Infect Control Hosp Epidemiol 1988;9:302–308.Google Scholar
44.Wise, KA, Tosolini, FA. Epidemiological surveillance of Acinetobacter species. J Hosp Infect 1990;16:319–329.Google Scholar
45.French, GL, Casewell, MW, Roncoroni, AJ, Knight, S, Phillips, I. A hospital outbreak of antibiotic-resistant Acinetobacter anitratus: epidemiology and control. J Hosp Infect 1980;1:125–131.Google Scholar
46.Bergogne-Bérézin, E, Joly-Guillou, ML, Vieu, JF. Epidemiology of nosocomial infections due to Acinetobacter calcoaceticus. J Hosp Infect 1987; 10:105–113.Google Scholar
47.Graves, TA, Cioffi, WG, Mason, AD Jr, McManus, WF, Pruitt, BA Jr. Relationship of transfusion and infection in a burn population. J Trauma 1989;29:948–954.Google Scholar
48.Agarwal, N, Murphy, JG, Cayten, G, Stahl, WM. Blood transfusion increases the risk of infection after trauma. Arch Surg 1993;128:171–177.Google Scholar
49.Papia, G, McLellan, BA, El-Helou, R, et al. Infection in hospitalized trauma patients: incidence, risk factors, and complications. J Trauma 1999; 47:923–927.Google Scholar
50.Blumberg, N, Heal, JM. Transfusion and recipient immune function. Arch Pathol Lab Med 1989;113:246–253.Google Scholar