Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-14T04:36:24.489Z Has data issue: false hasContentIssue false
  • English
  • Français

Control of an Outbreak of Multidrug-Resistant Acinetobacter baumannii-calcoaceticus Colonization and Infection in an Intensive Care Unit (ICU) Without Closing the ICU or Placing Patients in Isolation

Published online by Cambridge University Press:  21 June 2016

Mark Wilks ,
Anne Wilson ,
Simon Warwick ,
Elizabeth Price ,
Daniel Kennedy ,
Andrew Ely  and
Michael R. Millar
Mark Wilks
Affiliation:
Division of Infection, Barts & The London NHS Trust, London, United Kingdom
Anne Wilson
Affiliation:
Division of Infection, Barts & The London NHS Trust, London, United Kingdom
Simon Warwick
Affiliation:
Division of Infection, Barts & The London NHS Trust, London, United Kingdom
Elizabeth Price
Affiliation:
Division of Infection, Barts & The London NHS Trust, London, United Kingdom
Daniel Kennedy
Affiliation:
Intensive Care Unit, Barts & The London NHS Trust, London, United Kingdom
Andrew Ely
Affiliation:
Intensive Care Unit, Barts & The London NHS Trust, London, United Kingdom
Michael R. Millar*
Affiliation:
Division of Infection, Barts & The London NHS Trust, London, United Kingdom
*
Department of Microbiology, Royal London Hospital, Pathology and Pharmacy Building, 80 Newark Street, London El 2ES, United Kingdom (m.r.millar@qmul.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To describe the control of multidrug-resistant Acinetobacter baumannii-calcoaceticus (MDRABC) colonization and infection in an intensive care unit (ICU).

Setting.

An 18-bed ICU in a large tertiary care teaching hospital in London.

Interventions.

After recognition of the outbreak, a range of infection control measures were introduced over several months that were primarily aimed at reducing environmental contamination with the outbreak strain. Strategies included use of a closed tracheal suction system for all patients receiving mechanical ventilation, use of nebulized colistin for patients with evidence of mild to moderate ventilator-associated pneumonia, improved availability of alcohol for hand decontamination, and clearer designation of responsibilities and strategies for cleaning equipment and the environment in the proximity of patients colonized or infected with MDRABC.

Results.

The outbreak lasted from June 2001 through November 2002 and involved 136 new cases of MDRABC infection or colonization. The number of newly diagnosed cases per month reached a maximum of 15 in February 2002, and the number of new cases slowly decreased over the next 9 months.

Conclusion.

This outbreak was controlled by emphasizing the control of environmental reservoirs and did not require recourse to ward closure or placement of affected patients in isolation.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 7 , July 2006 , pp. 654 - 658
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Villegas, MV, Hartstein, AI. Acinetobacter outbreaks, 1977-2000. Infect Control Hosp Epidemiol 2003; 24:284–295.Google Scholar
2. Smolyakov, R, Borer, A, Riesenberg, K, et al. Nosocomial multi-drug resistant Acinetobacter baumannii bloodstream infection: risk factors and outcome with ampicillin-sulbactam treatment. J Hosp Infect 2003; 54:32–38.Google Scholar
3. Landman, D, Quale, JM, Mayorga, D, 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.Google Scholar
4. Manuel, RJ, Yen Shin, G, Farrag, N, Holliman, R. Endemic carbapenem-resistant Acinetobacter baumannii in a London hospital. J Antimicrob Chemother 2003; 52:141–142.CrossRefGoogle Scholar
5. Simor, AE, Lee, M, Vearncombe, M, et al. An outbreak due to multiresistant Acinetobacter baumannii in a burn unit: risk factors for acquisition and management. Infect Control Hosp Epidemiol 2002; 23:261–267.Google Scholar
6. Henwood, CJ, Gatward, T, Warner, M, et al. Antibiotic resistance among clinical isolates of Acinetobacter in the UK, and in vitro evaluation of tigecycline (GAR-936). J Antimicrob Chemother 2002; 49:479–487.Google Scholar
7. Coelho, J, Woodford, N, Turton, J, Livermore, DM. Multiresistant Acinetobacter in the UK: how big a threat? J Hosp Infect 2004; 58:167–169.Google Scholar
8. Hanberger, H, Garcia-Rodriguez, JA, Gobernado, M, Goossens, H, Nilsson, LE, Struelens, MJ. Antibiotic susceptibility among aerobic gram-negative bacilli in intensive care units in 5 European countries. French and Portuguese ICU Study Groups. JAMA 1999; 281:67–71.CrossRefGoogle ScholarPubMed
9. Andrews, JM. Antimicrobial susceptibility testing. BSAC Working Party on Susceptibility Testing. J Antimicrob Chemother 2001; 48(Suppl S1): 1–102.Google Scholar
10. A prevalent strain of Acinetobacter baumannii . CDR Weekly 2003; 13:34.Google Scholar
11. Turton, JF, Kaufmann, ME, Warner, M, et al. A prevalent, multiresistant clone of Acinetobacter baumannii in Southeast England. J Hosp Infect 2004; 58:170–179.Google Scholar
12. Garnacho, J, Sole-Violan, J, Sa-Borges, M, Diaz, E, Rello, J. Clinical impact of pneumonia caused by Acinetobacter baumannii in intubated patients: a matched cohort study. Crit Care Med 2003; 31:2478–2482.CrossRefGoogle ScholarPubMed
13. Michalopoulos, AS, Tsiodras, S, Rellos, K, Mentzelopoulos, S, Falagas, ME. Colistin treatment in patients with ICU-acquired infections caused by multiresistant gram-negative bacteria: the renaissance of an old antibiotic. Clin Microbiol Infect 2005; 11:115–121.Google Scholar
14. Houang, ETS, Chu, YW, Leung, CM, et al. Epidemiology and infection control implications of Acinetobacter spp. in Hong Kong. J Clin Microbiol 2001; 39:228–234.Google Scholar
15. Catalano, M, Quelle, LS, Jeric, PE, Di Martino, A, Maimone, SM. Survival of Acinetobacter baumannii on bed rails during an outbreak and during sporadic cases. J Hosp Infect 1999; 42:27–35.Google Scholar
16. Denton, M, Wilcox, MH, Parnell, P, et al. Role of environmental cleaning in controlling an outbreak of Acinetobacter baumannii on a neurosurgical intensive care unit. J Hosp Infect 2004; 56:106–110.Google Scholar
17. Fierobe, L, Lucet, JC, Decre, 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
18. Chen, MZ, Hsueh, PR, Lee, LN, Yu, CJ, Yang, PC, Luh, KT. Severe community-acquired pneumonia due to Acinetobacter baumannii . Chest 2001; 120:1072–1077.CrossRefGoogle ScholarPubMed
19. McDonald, LC, Walker, M, Carson, L, et al. Outbreak of Acinetobacter spp. bloodstream infections in a nursery associated with contaminated aerosols and air conditioners. Pediatr Infect Dis J 1998; 17:716–722.CrossRefGoogle Scholar
20. Smith, PW, Massanari, RM. Room humidifiers as the source of Acinetobacter infections. JAMA 1977; 237:795–797.Google Scholar
21. Jawad, A, Heritage, J, Snelling, AM, Gascoyne-Binzi, DM, Hawkey, PM. Influence of relative humidity and suspending menstrua on survival of Acinetobacter spp. on dry surfaces. J Clin Microbiol 1996; 34:2881–2887.Google Scholar