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Epidemiologic, Clinical, and Economic Evaluation of an Outbreak of Clonal Multidrug-Resistant Acinetobacter baumannii Infection in a Surgical Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Lisa S. Young ,
Allison L. Sabel  and
Connie S. Price
Lisa S. Young*
Affiliation:
Department of Medicine, Division of Infectious Diseases, University of Colorado Health Sciences Center, Denver, Colorado Greater Denver Infectious Diseases, Denver, Colorado
Allison L. Sabel
Affiliation:
Department of Preventative Medicine and Biometry, University of Colorado Health Sciences Center, Denver, Colorado Denver Health Medical Center, Denver, Colorado
Connie S. Price
Affiliation:
Department of Medicine, Division of Infectious Diseases, University of Colorado Health Sciences Center, Denver, Colorado
*
669 S. Gilpin St., Denver, CO 80209 ([email protected])
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Abstract

Objectives.

To determine risk factors for acquisition of multidrug-resistant (MDR) Acinetobacter baumannii infection during an outbreak, to describe the clinical manifestations of infection, and to ascertain the cost of infection.

Design.

Case-control study.

Setting.

Surgical intensive care unit in a 400-bed urban teaching hospital and level 1 trauma center.

Patients.

Case patients received a diagnosis of infection due to A. baumannii isolates with a unique pattern of drug resistance (ie, susceptible to imipenem, variably susceptible to aminoglycosides, and resistant to all other antibiotics) between December 1, 2004, and August 31, 2005. Case patients were matched 1 : 1 with concurrently hospitalized control patients. Isolates' genetic relatedness was established by pulsed-field gel electrophoresis.

Results.

Sixty-seven patients met the inclusion criteria. Case and control patients were similar with respect to age, duration of hospitalization, and Charlson comorbidity score. MDR A. baumannii infections included ventilator-associated pneumonia (in 56.7% of patients), bacteremia (in 25.4%), postoperative wound infections (in 25.4%), central venous catheter-associated infections (in 20.9%), and urinary tract infections (in 10.4%). Conditional multiple logistic regression was used to determine statistically significant risk factors on the basis of results from the bivariate analyses. The duration of hospitalization and healthcare charges were modeled by multiple linear regression. Significant risk factors included higher Acute Physiology and Chronic Health Evaluation II score (odds ratio [OR], 1.1 per point increase; P = .06), duration of intubation (OR, 1.4 per day intubated; P<.01), exposure to bronchoscopy (OR, 22.7; P = .03), presence of chronic pulmonary disease (OR, 77.7; P = .02), receipt of fluconazole (OR, 73.3; P<.01), and receipt of levofloxacin (OR, 11.5; P = .02). Case patients had a mean of $60,913 in attributable excess patient charges and a mean of 13 excess hospital days.

Interventions.

Infection control measures included the following: limitations on the performance of pulsatile lavage wound debridement, the removal of items with upholstered surfaces, and the implementation of contact isolation for patients with suspected MDR A. baumannii infection.

Conclusions.

This large outbreak of infection due to clonal MDR A. baumannii caused significant morbidity and expense. Aerosolization of MDR A. baumannii during pulsatile lavage debridement of infected wounds and during the management of respiratory secretions from colonized and infected patients may promote widespread environmental contamination. Multifaceted infection control interventions were associated with a decrease in the number of MDR A. baumannii isolates recovered from patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 11 , November 2007 , pp. 1247 - 1254
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1.Henriksen, SD. Moraxella, Acinetobacter, and the Mimeae. Bacteriol Rev 1973;37:522–561.CrossRefGoogle ScholarPubMed
2.Bergogne-Berezin, E, Towner, KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996;9:148–165.CrossRefGoogle ScholarPubMed
3.McBride, ME, Duncan, WC, Knox, JM. The environment and the microbial ecology of human skin. Appl Environ Microbiol 1977;33:603–608.CrossRefGoogle ScholarPubMed
4.Bernards, AT, Frenay, HM, Lim, BT, Hendriks, WD, Dijkshoorn, L, van Boven, CP. Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii: an unexpected difference in epidemiologic behavior. Am J Infect Control 1998;26:544–551.CrossRefGoogle ScholarPubMed
5.Wagenvoort, JH, Joosten, EJ. An outbreak Acinetobacter baumannii that mimics MRSA in its environmental longevity. J Hosp Infect 2002;52:226–227.Google Scholar
6.Struelens, MJ, Carlier, E, Maes, N, Serruys, E, Quint, WG, van Belkum, A. Nosocomial colonization and infection with multiresistant Acinetobacter baumannii: outbreak delineation using DNA macrorestriction analysis and PCR-fingerprinting. J Hosp Infect 1993;25:15–32.CrossRefGoogle ScholarPubMed
7.Bayuga, S, Zeana, C, Sahni, J, Della-Latta, P, el-Sadr, W, Larson, E. Prevalence and antimicrobial patterns of Acinetobacter baumannii on hands and nares of hospital personnel and patients: the iceberg phenomenon again. Heart Lung 2002;31:382–390.Google Scholar
8.El Shafie, SS, Alishaq, M, Leni Garcia, M. Investigation of an outbreak of multidrug-resistant Acinetobacter baumannii in trauma intensive care unit. J Hosp Infect 2004;56:101–105.Google Scholar
9.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
10.Villers, D, Espaze, E, Coste-Burel, M, et al. Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med 1998;129:182–189.Google Scholar
11.Abbo, A, Navon-Venezia, S, Hammer-Muntz, O, Krichali, T, Siegman-Igra, Y, Carmeli, Y. Multidrug-resistant Acinetobacter baumannii. Emerg Infect Dis 2005;11:22–29.Google Scholar
12.Manikal, VM, Landman, D, Saurina, G, Oydna, E, Lai, H, Quale, J. Endemic carbapenem-resistant Acinetobacter species in Brooklyn, New York: city-wide prevalence, interinstitutional spread, and relation to antibiotic usage. Clin Infect Dis 2000;31:101–106.CrossRefGoogle Scholar
13.Maragakis, LL, Cosgrove, SE, Song, X, et al. An outbreak of multidrug-resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment. JAMA 2004;292:3006–3011.Google Scholar
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.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.Google Scholar
16.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
17.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.Google Scholar
18.Faoagali, J, Fong, J, George, N, Mahoney, P, O'Rourke, V. Comparison of the immediate, residual, and cumulative antibacterial effects of Novaderm R,* Novascrub R,* Betadine Surgical Scrub, Hibiclens, and liquid soap. Am J Infect Control 1995;23:337–343.Google Scholar
19.Clinical and Laboratory Standards Institute (CLSI). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. Wayne, PA: CLSI;2006:M7–A7.Google Scholar
20.Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing: 15th Informational Supplement. Wayne, PA: CLSI;2005:M100–S15.Google Scholar
21.Murray, BE, Singh, KV, Heath, JD, Sharma, BR, Weinstock, GM. Comparison of genomic DNAs of different enterococcal isolates using restriction endonucleases with infrequent recognition sites. J Clin Microbiol 1990;28:2059–2063.Google Scholar
22.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.CrossRefGoogle ScholarPubMed
23.Mulin, B, Rouget, C, Clement, C, et al. Association of private isolation rooms with ventilator-associated Acinetobacter baumannii pneumonia in a surgical intensive care unit. Infect Control Hosp Epidemiol 1997;18:499–503.Google Scholar
24.Brooks, SE, Walczak, MA, Rizwanullah, H. Are we doing enough to contain Acinetobacter infections? Infect Control Hosp Epidemiol 2000;21:304.Google Scholar
25.Das, I, Lambert, P, Hill, D, Noy, M, Bion, J, Elliott, T. Carbapenem-resistant Acinetobacter and role of curtains in an outbreak in intensive care units. J Hosp Infect 2002;50:110–114.CrossRefGoogle Scholar
26.Nunez, S, Moreno, A, Green, K, Villar, J. The stethoscope in the emergency department: a vector of infection? Epidemiol Infect 2000;124:233–237.Google Scholar
27.Cisneros, JM, Reyes, MJ, Pachon, J, et al. Bacteremia due to Acinetobacter baumannii: epidemiology, clinical findings, and prognostic features. Clin Infect Dis 1996;22:1026–1032.Google Scholar
28.Rodriguez-Bano, J, Cisneros, JM, Fernandez-Cuenca, F, et al. Clinical features and epidemiology of Acinetobacter baumannii colonization and infection in Spanish hospitals. Infect Control Hosp Epidemiol 2004;25:819–824.CrossRefGoogle ScholarPubMed