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Failure to Communicate: Transmission of Extensively Drug-Resistant blaOXA-237-Containing Acinetobacter baumannii—Multiple Facilities in Oregon, 2012–2014

Published online by Cambridge University Press:  05 September 2017

Genevieve L. Buser ,
P. Maureen Cassidy ,
Margaret C. Cunningham ,
Susan Rudin ,
Andrea M. Hujer ,
Robert Vega ,
Jon P. Furuno ,
Steven H. Marshall ,
Paul G. Higgins  and
Michael R. Jacobs
...Show all authors
Genevieve L. Buser*
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon
P. Maureen Cassidy
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon
Margaret C. Cunningham
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon
Susan Rudin
Affiliation:
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Andrea M. Hujer
Affiliation:
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Robert Vega
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon
Jon P. Furuno
Affiliation:
Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, Oregon
Steven H. Marshall
Affiliation:
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Paul G. Higgins
Affiliation:
Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany German Center for Infection Research (DZIF), Partner Site, Bonn-Cologne, Germany
Michael R. Jacobs
Affiliation:
Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
Meredith S. Wright
Affiliation:
J. Craig Venter Institute, La Jolla, California
Mark D. Adams
Affiliation:
J. Craig Venter Institute, La Jolla, California
Robert A. Bonomo
Affiliation:
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Departments of Pharmacology, Molecular Biology and Microbiology, Biochemistry, and Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio
Christopher D. Pfeiffer
Affiliation:
Department of Hospital & Specialty Medicine, VA Portland Health Care System, Portland, Oregon Division of Infectious Diseases, Department of Medicine, Oregon Health & Science University, Portland, Oregon
Zintars G. Beldavs
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon
*
Address correspondence to Genevieve L. Buser, MDCM, MSHP, Providence St Vincent Medical Center, 9427 SW Barnes Road, Suite 395, Portland, Oregon 97225 ([email protected]).
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Abstract

OBJECTIVE

To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii.

DESIGN

Outbreak investigation.

SETTING AND PARTICIPANTS

Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals.

METHODS

A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed.

RESULTS

We identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n=8), or skilled nursing facility A (n=8), or both (n=1) prior to XDR A. baumannii isolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase gene blaOXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission.

CONCLUSIONS

Interfacility transmission of XDR A. baumannii carrying the rare blaOXA-237 was facilitated by transfer of affected patients without communication to receiving facilities.

Infect Control Hosp Epidemiol 2017;38:1335–1341

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 11 , November 2017 , pp. 1335 - 1341
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. These data were presented in part as “Investigation of First Carbapenem-Resistant Acinetobacter baumannii Outbreak in Oregon—Multi-Facility, 2012–2013” at the 2014 Council for State and Territorial Epidemiologists Annual Conference on June 23, 2014, in Nashville, Tennessee.

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