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An Outbreak of Multidrug-Resistant Pseudomonas Aeruginosa Associated with Increased Risk of Patient Death in an Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Geir Bukholm ,
Tone Tannæs ,
Anne Britt Bye Kjelsberg  and
Nils Smith-Erichsen
Geir Bukholm*
Affiliation:
Institute of Clinical Epidemiology and Molecular Biology, Akershus University Hospital, University of Oslo, Oslo, Norway
Tone Tannæs
Affiliation:
Institute of Clinical Epidemiology and Molecular Biology, Akershus University Hospital, University of Oslo, Oslo, Norway
Anne Britt Bye Kjelsberg
Affiliation:
Institute of Clinical Epidemiology and Molecular Biology, Akershus University Hospital, University of Oslo, Oslo, Norway
Nils Smith-Erichsen
Affiliation:
Department of Anesthesiology, Akershus University Hospital, University of Oslo, Oslo, Norway
*
Institute of Clinical Epidemiology and Molecular Biology, Akershus University Hospital, University of Oslo, N-1474 Nordbyhagen, Norway
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Abstract

Objective:

To investigate an outbreak of multidrug-resistant Pseudomonas aeruginosa in an intensive care unit (ICU).

Design:

Epidemiologic investigation, environmental assessment, and ambidirectional cohort study.

Setting:

A secondary-care university hospital with a 10-bed ICU.

Patients:

All patients admitted to the ICU receiving ventilator treatment from December 1,1999, to September 1, 2000.

Results:

An outbreak in an ICU with multidrug-resistant isolates of P. aeruginosa belonging to one amplified fragment-length polymorphism (AFLP)–defined genetic cluster was identified, characterized, and cleared. Molecular typing of bacterial isolates with AFLP made it possible to identify the outbreak and make rational decisions during the outbreak period. The outbreak included 19 patients during the study period. Infection with bacterial isolates belonging to the AFLP cluster was associated with reduced survival (odds ratio, 5.26; 95% confidence interval, 1.14 to 24.26). Enhanced barrier and hygiene precautions, cohorting of patients, and altered antibiotic policy were not sufficient to eliminate the outbreak. At the end of the study period (in July), there was a change in the outbreak pattern from long (December to June) to short Quly) incubation times before colonization and from primarily tracheal colonization (December to June) to primarily gastric or enteral Quly) colonization. In this period, the bacterium was also isolated from water taps.

Conclusion:

Complete elimination of the outbreak was achieved after weekly pasteurization of the water taps of the ICU and use of sterile water as a solvent in the gastric tubes.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 8 , August 2002 , pp. 441 - 446
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.Ewig, S, Torres, A, El-Ebiary, M, et al. Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury: incidence, risk factors, and association with ventilator-associated pneumonia. Am JRespir Crit Care Med 1999;159:188–198.Google Scholar
2.Estes, RJ, Meduri, GU. The pathogenesis of ventilator-associated pneumonia: I. Mechanisms of bacterial transcolonization and airway inoculation. Intensive Care Medicine 1995;21:365–383.Google Scholar
3.Richet, H, Escande, MC, Marie, JP, Zittoun, R, Lagrange, PH. Epidemic Pseudomonas aeruginosa serotype O16 bacteremia in hematology-oncology patients. J Clin Microbiol 1989;27:1992–1996.Google Scholar
4.Mayhall, CG. Nosocomial pneumonia: diagnosis and prevention. Infect Dis Clin North Am 1997;11:427–457.Google Scholar
5.Griffith, SJ, Nathan, C, Selander, RK, et al. The epidemiology of Pseudomonas aeruginosa in oncology patients in a general hospital. J Infect Dis 1989;160:1030–1036.CrossRefGoogle ScholarPubMed
6.Ferroni, A, Nguyen, L, Pron, B, Quesne, G, Brusset, MC, Berche, P. Outbreak of nosocomial urinary tract infections due to Pseudomonas aeruginosa in a paediatric surgical unit associated with tap-water contamination. J Hosp Infect 1998;39:301–307.Google Scholar
7.Bert, F, Maubec, E, Bruneau, B, Berry, P, Lambert-Zechovsky, N. Multi-resistant Pseudomonas aeruginosa outbreak associated with contaminated tap water in a neurosurgery intensive care unit. J Hosp Infect 1998; 39:53–62.Google Scholar
8.Hoque, SN, Graham, J, Kaufmann, ME, Tabaqchali, S. Chryseobacterium (Flavobacterium) meningosepticum outbreak associated with colonization of water taps in a neonatal intensive care unit. J Hosp Infect 2001; 47:188–192.Google Scholar
9.Farmer, JJ 3rd, Weinstein, RAZierdt, CH, Brokopp, CD. Hospital outbreaks caused by Pseudomonas aeruginosa: importance of serogroup O11. J Clin Microbiol 1982;16:266–270.CrossRefGoogle ScholarPubMed
10.Elaichouni, A, Verschraegen, G, Claeys, G, Devleeschouwer, M, Godard, C, Vaneechoutte, M. Pseudomonas aeruginosa serotype O12 outbreak studied by arbitrary primer PCR. J Clin Microbiol 1994;32:667–671.Google Scholar
11.Anderson, DJ, Kuhns, JS, Vasil, ML, Gerding, DN, Janoff, EN. DNA fingerprinting by pulsed field gel electrophoresis and ribotyping to distinguish Pseudomonas cepacia isolates from a nosocomial outbreak. J Clin Microbiol 1991;29:648–649.Google Scholar
12.Blanc, DS, Siegrist, HH, Sahli, R, Francioli, P. Ribotyping of Pseudomonas aeruginosa: discriminatory power and usefulness as a tool for epidemiological studies. J Clin Microbiol 1993;31:71–77.Google Scholar
13.De Vos, D, Lim, A Jr, Pirnay, JP, et al. Analysis of epidemic Pseudomonas aeruginosa isolates by isoelectric focusing of pyoverdine and RAPD-PCR: modern tools for an integrated anti-nosocomial infection strategy in burn wound centres. Burns 1997;23:379–386.Google Scholar
14.Savelkoul, PH, Aarts, HJ, de Haas, J, et al. Amplified-fragment length polymorphism analysis: the state of an art. J Clin Microbiol 1999;37:3083–3091.Google Scholar
15.Geornaras, I, Kunene, NF, von Holy, A, Hastings, JW. Amplified fragment length polymorphism fingerprinting of Pseudomonas strains from a poultry processing plant. Appl Environ Microbiol 1999;65:3828–3833.Google Scholar
16.Le Gall, JR, Lemeshow, S, Saulnier, F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2957–2963.CrossRefGoogle ScholarPubMed
17.Boom, R, Sol, CJ, Salimans, MM, Jansen, CL, Wertheim-van Dillen, PM, van der Noordaa, J. Rapid and simple method for purification of nucleic acids. J Clin Microbiol 1990;28:495–503.Google Scholar
18.Koeleman, JG, Stoof, J, Biesmans, DJ, Savelkoul, PH, Vandenbroucke-Grauls, CM. Comparison of amplified ribosomal DNA restriction analysis, random amplified polymorphic DNA analysis, and amplified fragment length polymorphism fingerprinting for identification of Acinetobacter genomic species and typing of Acinetobacter baumannii. J Clin Microbiol 1998;36:2522–2529.Google Scholar
19.Speijer, H, Savelkoul, PH, Bonten, MJ, Stobberingh, EE, Tjhie, JH. Application of different genotyping methods for Pseudomonas aeruginosa in a setting of endemicity in an intensive care unit. J Clin Microbiol 1999;37:3654–3661.Google Scholar
20.Kaye, J, Ashline, V, Erickson, D, et al. Critical care bug team: a multidis-ciplinary team approach to reducing ventilator-associated pneumonia. Am J Infect Control 2000;28:197–201.CrossRefGoogle Scholar
21.Trick, WE, Kioski, CM, Howard, KM, et al. Outbreak of Pseudomonas aeruginosa ventriculitis among patients in a neurosurgical intensive care unit. Infect Control Hosp Epidemiol 2000;21:204–208.Google Scholar
22.Moolenaar, RL, Crutcher, JM, San Joaquin, VH, et al. A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission? Infect Control Hosp Epidemiol 2000;21:80–85.Google Scholar
23.Hsueh, PR, Teng, LJ, Yang, PC, Chen, YC, Ho, SW, Luh, KT. Persistence of a multidrug-resistant Pseudomonas aeruginosa clone in an intensive care burn unit. J Clin Microbiol 1998;36:1347–1351.Google Scholar
24.Becks, VE, Lorenzoni, NM. Pseudomonas aeruginosa outbreak in a neonatal intensive care unit: a possible link to contaminated hand lotion. Am J Infect Control 1995;23:396–398.Google Scholar
25.Jumaa, P, Chattopadhyay, B. Outbreak of gentamicin, ciprofloxacin-resistant Pseudomonas aeruginosa in an intensive care unit, traced to contaminated quivers. J Hosp Infect 1994;28:209–218.CrossRefGoogle Scholar
26.Fagon, JY, Novara, A, Stephan, F, Girou, E, Safar, M. Mortality attributable to nosocomial infections in the ICU. Infect Control Hosp Epidemiol 1994; 15:428–434.Google Scholar
27.Fagon, JY, Chastre, J, Domart, Y, Trouillet, JL, Gibert, C. Mortality due to ventilator-associated pneumonia or colonization with Pseudomonas or Acinetobacter species: assessment by quantitative culture of samples obtained by a protected specimen brush. Clin Infect Dis 1996;23:538–542.Google Scholar