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Multidrug-Resistant Acinetobacter baumannii Infection, Colonization, and Transmission Related to a Long-Term Care Facility Providing Subacute Care

Published online by Cambridge University Press:  10 May 2016

Eva Mortensen ,
Kavita K. Trivedi ,
Jon Rosenberg ,
Sara H. Cody ,
Janet Long ,
Bette J. Jensen  and
Duc J. Vugia
Eva Mortensen
Affiliation:
Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Kavita K. Trivedi
Affiliation:
Healthcare Associated Infections Program, Center for Health Care Quality, California Department of Public Health, Richmond, California
Jon Rosenberg
Affiliation:
Healthcare Associated Infections Program, Center for Health Care Quality, California Department of Public Health, Richmond, California
Sara H. Cody
Affiliation:
Santa Clara County Public Health Department, San Jose, California
Janet Long
Affiliation:
John Muir Health, Concord, California
Bette J. Jensen
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Duc J. Vugia*
Affiliation:
Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California
*
Infectious Diseases Branch, 850 Marina Bay Parkway, Building P, 2nd Floor, Richmond, CA 94804 ([email protected])
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Abstract

Objective.

To investigate Acinetobacter baumannii infection, colonization, and transmission related to a long-term care facility (LTCF) providing subacute care (facility A).

Methods.

We reviewed facility A and affiliated local hospital records for facility A residents with A. baumannii isolated during the period January 2009 through February 2010 and compared A. baumannii antimicrobial resistance patterns of residents with those of hospital patients. During March 2010, we implemented a colonization survey of facility A residents who received respiratory support or who could provide sputum samples and looked for A. baumannii colonization risks. Available clinical and survey isolates underwent pulsed-field gel electrophoresis (PFGE); PFGE strains were linked with overlapping stays to identify possible transmission.

Results.

During the period January 2009 through February 2010, 33 facility A residents had A. baumannii isolates; all strains were multidrug resistant (MDR), which was a significantly higher prevalence of MDR strains than that found among isolates from hospital patients (81 [66%] of 122 hospital patient isolates were MDR; P < .001). The sputum survey found that 14 (20%) of 70 residents had A. baumannii colonization, which was associated with ventilator use (adjusted odds ratio, 4.24 [95% confidence interval, 1.06–16.93]); 12 (86%) of 14 isolates were MDR. Four facility A resident groups clustered with 3 PFGE strains and overlapping stays. One of these facility A residents also clustered with 3 patients at an affiliated hospital.

Conclusions.

We documented substantial MDR A. baumannii infections and colonization with probable intra- and interfacility spread associated with a single LTCF providing subacute care. Given the limited infection prevention and antimicrobial stewardship resources in such settings, regional collaborations among facilities across the spectrum of health care are needed to address this MDR threat.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 4: Special Topic Issue: Carbapenem-Resistant Enterobacteriaceae and Multidrug-Resistant Organisms , April 2014 , pp. 406 - 411
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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References

1. Johnson, NA, Simpkins, SM, Hipona, P, Hamilton, JR, Stevens, DA. Resistant Acinetobacter baumannii hospital outbreak from a community source. In: Program and abstracts of the 38th Annual Education Conference and International Meeting of the Association for Professionals in Infection Control and Epidemiology (APIC). Baltimore, MD: APIC, 2011. Abstract 1–003.Google Scholar
2. 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(10):819–824.CrossRefGoogle ScholarPubMed
3. Bergogne-Berezin, E, Towner, KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996;9(2):148–165.CrossRefGoogle ScholarPubMed
4. Sunenshine, RH, Wright, MO, Maragakis, LL, et al. Multidrug-resistant Acinetobacter infection mortality rate and length of hospitalization. Emerg Infect Dis 2007;13(1):97–103.CrossRefGoogle ScholarPubMed
5. Choi, WS, Kim, SH, Jeon, EG, et al. Nosocomial outbreak of carbapenem-resistant Acinetobacter baumannii in intensive care units and successful outbreak control program. J Korean Med Sci 2010;25(7):999–1004.CrossRefGoogle ScholarPubMed
6. Maragakis, LL, Perl, TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008;46(8):1254–1263.CrossRefGoogle ScholarPubMed
7. Infectious Diseases Society of America. Bad bugs, no drugs. July 2004. http://www.idsociety.org/uploadedfiles/idsa/policy_and_advocacy/current_topics_and_issues/antimicrobial_resistance/10x20/images/bad%20bugs%20no%20drugs.pdf. Accessed October 22, 2013.Google Scholar
8. Boucher, HW, Talbot, GH, Bradley, JS, et al. Bad bugs, no drugs: no ESKAPE! an update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48(1):1–12.CrossRefGoogle ScholarPubMed
9. Sengstock, DM, Thyagarajan, R, Apalara, J, Mira, A, Chopra, T, Kaye, KS. Multidrug-resistant Acinetobacter baumannii: an emerging pathogen among older adults in community hospitals and nursing homes. Clin Infect Dis 2010;50(12):1611–1616.CrossRefGoogle ScholarPubMed
10. de Medina, T, Carmeli, Y. The pivotal role of long-term care facilities in the epidemiology of Acinetobacter baumannii: another brick in the wall. Clin Infect Dis 2010;50(12):1617–1618.CrossRefGoogle ScholarPubMed
11. California Association of Health Facilities. Guide to long-term care. http://www.cahf.org/AboutCAHF/ConsumerHelp/GuideToLongTermCare.aspx. Accessed October 22, 2013.Google Scholar
12. Prabaker, K, Lin, MY, McNally, M, et al. Transfer from high-acuity long-term care facilities is associated with carriage of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. a multihospital study. Infect Control Hosp Epidemiol 2012;33(12):1193–1199.CrossRefGoogle ScholarPubMed
13. Thom, KA, Maragakis, LL, Richards, K, et al. Assessing the burden of Acinetobacter baumannii in Maryland: a statewide cross-sectional period prevalence survey. Infect Control Hosp Epidemiol 2012;33(9):883–888.Google ScholarPubMed
14. Magiorakos, AP, Srinivasan, A, Carey, RB, et al. 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(3):268–281.CrossRefGoogle ScholarPubMed
15. 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(9):2233–2239.CrossRefGoogle ScholarPubMed
16. Dean, AG, Sullivan, KM, Soe, MM. OpenEpi: open source epidemiologic statistics for public health, version 2.3.1. http://www.OpenEpi.com. Accessed October 28, 2013.Google Scholar
17. Bernards, AT, Harinck, HI, Dijkshoorn, L, van der Reijden, TJ, van den Broek, PJ. Persistent Acinetobacter baumannii? look inside your medical equipment. Infect Control Hosp Epidemiol 2004;25(11):1002–1004.CrossRefGoogle ScholarPubMed
18. Munoz-Price, LS. Long-term acute care hospitals. Clin Infect Dis 2009;49(3):438–443.CrossRefGoogle ScholarPubMed
19. Kahn, JM. The evolving role of dedicated weaning facilities in critical care. Intensive Care Med 2010;36(1):8–10.CrossRefGoogle ScholarPubMed
20. Lin, MY, Lyles-Banks, RD, Lolans, K. The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumonia carbapenemase–producing Enterobacteriaceae . Clin Infect Dis 2013;57(9):1246–1252.CrossRefGoogle ScholarPubMed
21. Marquez, P, Terashita, D. Long-term acute care hospitals and carbapenem-resistant Enterobacteriaceae. a reservoir for transmission. Clin Infect Dis 2013;57(9):1253–1255.CrossRefGoogle ScholarPubMed
22. Furuno, JP, Hebden, JN, Standiford, HC, et al. Prevalence of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii in a long-term acute care facility. Am J Infect Control 2008;36(7):468–471.CrossRefGoogle Scholar
23. Cunha, BA. Acinetobacter. Medscape. October 19, 2009. http://emedicine.medscape.com/article/236891-print. Accessed September 9, 2011.Google ScholarPubMed
24. Smith, PW, Watkins, K, Miller, H, et al. Antibiotic stewardship programs in long-term care facilities. Ann Long Term Care 2011;19(4):20–25.Google Scholar
25. Apisarnthanarak, A, Warren, DK. Screening for carbapenem-resistant Acinetobacter baumannii colonization sites: an implication for combination of horizontal and vertical approaches. Clin Infect Dis 2013;56(7):1057–1059.CrossRefGoogle ScholarPubMed
26. Marchaim, D, Navon-Venezia, S, Schwartz, D, et al. Surveillance cultures and duration of carriage of multidrug-resistant Acinetobacter baumannii . J Clin Microbiol 2007;45(5):1551–1555.CrossRefGoogle ScholarPubMed
27. Mielke, M. Prevention and control of nosocomial infections and resistance to antibiotics in Europe: primum non-nocere: elements of successful prevention and control of healthcare-associated infections. Int J Med Microbiol 2010;300(6):346–350.CrossRefGoogle ScholarPubMed
28. Schwaber, MJ, Lev, B, Israeli, A, et al. Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011;52(7):848–855.CrossRefGoogle Scholar
29. Ostrowsky, BE, Trick, WE, Sohn, AH, et al. Control of vancomycin-resistant enterococcus in health care facilities in a region. N Engl J Med 2001;344(19):1427–1433.CrossRefGoogle ScholarPubMed