Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-06-01T09:31:19.529Z Has data issue: false hasContentIssue false
  • English
  • Français

Nosocomial Outbreak of Infection With Multidrug-Resistant Acinetobacter baumannii in a Medical Center in Taiwan

Published online by Cambridge University Press:  02 January 2015

Hui-Lan Chang ,
Chih-Hsin Tang ,
Yuan-Man Hsu ,
Lei Wan ,
Ya-Fen Chang ,
Chiung-Tsung Lin ,
Yao-Ru Tseng ,
Ying-Ju Lin ,
Jim Jinn-Chyuan Sheu  and
Cheng-Wen Lin
...Show all authors
Hui-Lan Chang
Affiliation:
Department of Laboratory Medicine, China Medical University Hospital, Taichung
Chih-Hsin Tang
Affiliation:
Department of Pharmacology, School of Medicine, China Medical University, Taichung
Yuan-Man Hsu
Affiliation:
Department of Biological Science and Technology, China Medical University, Taichung
Lei Wan
Affiliation:
Department of Medical Research, China Medical University Hospital, Taichung
Ya-Fen Chang
Affiliation:
Department of Laboratory Medicine, China Medical University Hospital, Taichung
Chiung-Tsung Lin
Affiliation:
Department of Laboratory Medicine, China Medical University Hospital, Taichung
Yao-Ru Tseng
Affiliation:
Department of Laboratory Medicine, China Medical University Hospital, Taichung
Ying-Ju Lin
Affiliation:
Department of Medical Research, China Medical University Hospital, Taichung
Jim Jinn-Chyuan Sheu
Affiliation:
Department of Medical Research, China Medical University Hospital, Taichung
Cheng-Wen Lin
Affiliation:
Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung
Yun-Chieh Chang
Affiliation:
Institute of Molecular and Cellular Biology, National Tsing Hua University, Hsinchu, Taiwan
Mao-Wang Ho
Affiliation:
Department of Internal Medicine, China Medical University Hospital, Taichung
Chia-Der Lin
Affiliation:
Department of Otolaryngology, China Medical University Hospital, Taichung
Cheng-Mao Ho*
Affiliation:
Department of Laboratory Medicine, China Medical University Hospital, Taichung Department of Internal Medicine, China Medical University Hospital, Taichung
Chih-Ho Lai*
Affiliation:
Department of Microbiology, School of Medicine, China Medical University, Taichung
*
Internal Medicine, China Medical University Hospital, 2 Yuh Der Road, Taichung, Taiwan (shihkuo.ho@msa.hinet.net)
Department of Microbiology, School of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, Taiwan (chl@mail.cmu.edu.tw)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To investigate a nosocomial outbreak of infection with multidrug-resistant (MDR) Acinetobacter baumannii in the intensive care units at China Medical University Hospital in Taiwan.

Design.

Prospective outbreak investigation.

Setting.

Three intensive care units in a 2,000-bed university hospital in Taichung, Taiwan.

Methods.

Thirty-eight stable patients in 3 intensive care units, all of whom had undergone an invasive procedure, were enrolled in our study. Ninety-four A. baumannii strains were isolated from the patients or the environment in the 3 intensive care units, during the period from January 1 through December 31, 2006. We characterized A. baumannii isolates by use of repetitive extragenic palindromic–polymerase chain reaction (REP-PCR) and random amplified polymorphic DNA (RAPD) fingerprinting. The clinical characteristics of the source patients and the environment were noted.

Results.

All of the clinical isolates were determined to belong to the same epidemic strain of MDR A. baumannii by the use of antimicrobial susceptibility tests, REP-PCR, and RAPD fingerprinting. All patients involved in the infection outbreak had undergone an invasive procedure. The outbreak strain was also isolated from the environment and the equipment in the intensive care units. Moreover, an environmental survey of one of the intensive care units found that both the patients and the environment harbored the same outbreak strain.

Conclusion.

The outbreak strain of A. baumannii might have been transmitted among medical staff and administration equipment. Routine and aggressive environmental and equipment disinfection is essential for preventing recurrent outbreaks of nosocomial infection with MDR A. baumannii.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 1 , January 2009 , pp. 34 - 38
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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.Bergogne-Berezin, E, Towner, KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996;9:148–165.Google Scholar
2.Cefai, C, Richards, J, Gould, FK, McPeake, P. An outbreak of Acinetobacter respiratory tract infection resulting from incomplete disinfection of ventilatory equipment. J Hosp Infect 1990;15:177–182.CrossRefGoogle ScholarPubMed
3.Siegman-Igra, Y, Bar-Yosef, S, Gorea, A, Avram, J. Nosocomial Acinetobacter meningitis secondary to invasive procedures: report of 25 cases and review. Clin Infect Dis 1993;17:843–849.CrossRefGoogle ScholarPubMed
4.Okpara, AU, Maswoswe, JJ. Emergence of multidrug-resistant isolates of Acinetobacter baumannii. Am J Hosp Pharm 1994;51:2671–2675.Google Scholar
5.Martin-Lozano, D, Cisneros, JM, Becerril, B, et al. Comparison of a repetitive extragenic palindromic sequence-based PCR method and clinical and microbiological methods for determining strain sources in cases of nosocomial Acinetobacter baumannii bacteremia. J Clin Microbiol 2002;40:4571–4575.Google Scholar
6.Bou, G, Cervero, G, Dominguez, MA, Quereda, C, Martinez-Beltran, J. PCR-based DNA fingerprinting (REP-PCR, AP-PCR) and pulsed-field gel electrophoresis characterization of a nosocomial outbreak caused by imipenem- and meropenem-resistant Acinetobacter baumannii. Clin Microbiol Infect 2000;6:635–643.CrossRefGoogle ScholarPubMed
7.Wisplinghoff, H, Edmond, MB, Pfaller, MA, Jones, RN, Wenzel, RP, Seifert, H. Nosocomial bloodstream infections caused by Acinetobacter species in United States hospitals: clinical features, molecular epidemiology, and antimicrobial susceptibility. Clin Infect Dis 2000;31:690–697.CrossRefGoogle ScholarPubMed
8.Fournier, PE, Richet, H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis 2006;42:692–699.CrossRefGoogle ScholarPubMed
9.CLSI. Performance standards for antimicrobial disk susceptibility tests; approved standard—ninth edition. CLSI document. Wayne, PA: CLSI,2006:M2–A9.Google Scholar
10.Snelling, AM, Gerner-Smidt, P, Hawkey, PM, et al. Validation of use of whole-cell repetitive extragenic palindromic sequence-based PCR (REP-PCR) for typing strains belonging to the Acinetobacter calcoaceticus-Acinetobacter baumannii complex and application of the method to the investigation of a hospital outbreak. J Clin Microbiol 1996;34:1193–1202.Google Scholar
11.Reboli, AC, Houston, ED, Monteforte, JS, Wood, CA, Hamill, RJ. Discrimination of epidemic and sporadic isolates of Acinetobacter baumannii by repetitive element PCR-mediated DNA fingerprinting. J Clin Microbiol 1994;32:2635–2640.CrossRefGoogle ScholarPubMed
12.Seifert, H, Schulze, A, Baginski, R, Pulverer, G. Comparison of four different methods for epidemiologic typing of Acinetobacter baumannii. J Clin Microbiol 1994;32:1816–1819.CrossRefGoogle ScholarPubMed
13.Seifert, H, Gerner-Smidt, P. Comparison of ribotyping and pulsed-field gel electrophoresis for molecular typing of Acinetobacter isolates. J Clin Microbiol 1995;33:1402–1407.Google Scholar
14.Bou, G, Cervero, G, Dominguez, MA, Quereda, C, Martinez-Beltran, J. Characterization of a nosocomial outbreak caused by a multiresistant Acinetobacter baumannii strain with a carbapenem-hydrolyzing enzyme: high-level carbapenem resistance in A. baumannii is not due solely to the presence of β-lactamases. J Clin Microbiol 2000;38:3299–3305.Google Scholar
15.Scerpella, EG, Wanger, AR, Armitige, L, Anderlini, P, Ericsson, CD. Nosocomial outbreak caused by a multiresistant clone of Acinetobacter baumannii: results of the case-control and molecular epidemiologic investigations. Infect Control Hosp Epidemiol 1995;16:92–97.Google Scholar
16.Scott, P, Deye, G, Srinivasan, A, et al. An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq. Clin Infect Dis 2007;44:1577–1584.Google Scholar
17.Getchell-White, SI, Donowitz, LG, Groschel, DH. The inanimate environment of an intensive care unit as a potential source of nosocomial bacteria: evidence for long survival of Acinetobacter calcoaceticus. Infect Control Hosp Epidemiol 1989;10:402–407.Google Scholar
18.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.CrossRefGoogle ScholarPubMed
19.Jawad, A, Snelling, AM, Heritage, J, Hawkey, PM. Exceptional desiccation tolerance of Acinetobacter radioresistens. J Hosp Infect 1998;39:235–240.CrossRefGoogle ScholarPubMed
20.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
21.Wendt, C, Dietze, B, Dietz, E, Ruden, H. Survival of Acinetobacter baumannii on dry surfaces. J Clin Microbiol 1997;35:1394–1397.Google Scholar
22.Peleg, AY, Seifert, H, Paterson, DL. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev 2008;21:538–582.CrossRefGoogle ScholarPubMed