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An Outbreak of Imipenem-Resistant Acinetobacter baumannii in Critically Ill Surgical Patients

  • Lisiane Fierobe (a1), Jean-Christophe Lucet (a2), Dominique Decré (a3), Claudette Muller-Serieys (a3), Arnaud Deleuze (a1), Marie-Laure Joly-Guillou (a3), Jean Mantz (a1) and Jean-Marie Desmonts (a1)...
Abstract
AbstractObjective:

To describe an outbreak of imipenem-resistant Acinetobacter baumannii (IR-Ab) and the measures for its control, and to investigate risk factors for IR-Ab acquisition.

Design:

An observational and a case-control study.

Setting:

A surgical intensive care unit (ICU) in a university tertiary care hospital.

Methods:

After admission to the ICU of an IR-Ab-positive patient, patients were prospectively screened for IR-Ab carriage upon admission and then once a week. Environmental cleaning and barrier safety measures were used for IR-Ab carriers. A case-control study was performed to identify factors associated with IR-Ab acquisition. Cases were patients who acquired IR-Ab. Controls were patients who were hospitalized in the ICU at the same time as cases and were exposed to IR-Ab for a similar duration as cases. The following variables were investigated as potential risk factors: baseline characteristics, scores for severity of illness and therapeutic intervention, presence and duration of invasive procedures, and antimicrobial administration.

Results:

Beginning in May 1996, the outbreak involved 17 patients over 9 months, of whom 12 acquired IR-Ab (cases), 4 had IR-Ab isolates on admission to the ICU, and 1 could not be classified. Genotypic analysis identified two different IR-Ab isolates, responsible for three clusters. Ten of the 12 nosocomial cases developed infection. Control measures included reinforcement of barrier safety measures, limitation of the number of admissions, and thorough environmental cleaning. No new case was identified after January 1997. Eleven of the 12 cases could be compared to 19 controls. After adjustment for severity of illness, a high individual therapeutic intervention score appeared to be a risk factor for IR-Ab acquisition.

Conclusion:

The outbreak ended after strict application of control measures. Our results suggest that high work load contributes to IR-Ab acquisition.

Copyright
Corresponding author
Department of Anesthesiology and Intensive Care, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75018 Paris, France
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1. JM Cisneros , MJ Reyes , J Paction , B Becerril , FJ Caballero , JL Garcia-Garmendia , et al. Bacteremia due to Acinetobacter baumannii: epidemiology, clinical findings, and prognostic features. Clin Infect Dis 1996;22:10261032.

2. C Urban , E Go , N Mariano , BJ Berger , I Avraham , D Rubin , et al. Effect of sulbactam on infections caused by imipenem-resistant Acinetobacter calcoaceticus biotype anitratus. J Infect Dis 1993;167:448451.

3. R Kaul , JA Burt , L Cork , H Dedier , M Garcia , C Kennedy , et al. Investigation of a multiyear multiple critical care unit outbreak due to relatively drug-sensitive Acinetobacter baumannii: risk factors and attributable mortality. J Infect Dis 1996;174:12791287.

4. J Contant , E Kemeny , C Oxley , E Perry , G Garber . Investigation of an outbreak of Acinetobacter calcoaceticus var anitratus infections in an adult intensive care unit. Am J Infect Control 1990;18:288291.

5. ES Go , C Urban , J Burns , B Kreiswirth , W Eisner , N Mariano , et al. Clinical and molecular epidemiology of Acinetobacter infections sensitive only to polymyxin B and sulbactam. Lancet 1994;344:13291332.

6. EG Scerpella , AR Wanger , L Armitige , P Anderlini , CD Erisson . Nosocomial outbreak caused by a multiresistant clone of Acinetobacter baumannii: results of the case-control and molecular epidemiologic investigations. Infect Control Hosp Epidemiol 1995;16:9297.

7. O Lortholary , JY Fagon , A Buu Hoi , MA Slama , J Pierre , P Giral , et al. Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis. Clin Infect Dis 1995;20:790796.

8. J Ayats , X Corbella , C Ardanuy , MA Dominguez , A Ricart , J Ariza , et al. Epidemiological significance of cutaneous, pharyngeal, and digestive tract colonization by multiresistant Acinetobacter baumannii in ICU patients. J Hosp Infect 1997;37:287295.

9. B Mulin , D Talon , JF Viel , C Vincent , R Leprat , M Thouverez , et al. Risk factors for nosocomial colonization with multiresistant Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis 1995;14:569576.

10. D Taplin , G Rebell , N Zaias . The human skin as a source of Mima Herellea infections. JAMA 1963;186:952955.

11. S Rosenthal , IB Tager . Prevalence of gram negative rods in the normal pharyngeal flora. Ann Intern Med 1975;83:355357.

12. X Corbella , M Pujol , J Ayats , M Sendra , C Ardanuy , MA Dominguez , et al. Relevance of digestive tract colonization in the epidemiology of nosocomial infections due to multiresistant Acinetobacter baumannii. Clin Infect Dis 1996;23:329333.

13. JF Timsit , V Garrait , B Misset , FW Goldstein , B Renaud , J Carlet . The digestive tract is a major site for Acinetobacter baumannii colonization in intensive care unit patients. J Infect Dis 1993;168:13361337.

14. AJ Hartstein , AI Rashad , JM Liebler , LA Actis , J Freeman , JW Rourke , et al. Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contaminated reusable ventilator circuits and resuscitation bags. Am J Med 1988;85:624631.

15. DH Gervich , CS Grout . An outbreak of nosocomial Acinetobacter infections from humidifiers. Am J Infect Control 1985;13:210215.

16. D Villers , E Espaze , M Coste-Burel , F Giauffret , E Ninin , F Nicolas , et al. Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med 1998;129:182189.

18. JS Garner , WR Jarvis , TG Emory , TC Horan , JM Hughes . CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128140.

19. J Chastre , JY Fagon , P Soler , M Bornet , Y Domart , JL Trouillet , et al. Diagnosis of nosocomial bacterial pneumoniae in intubated patients undergoing ventilation: comparison of the usefulness of bronchoalveolar lavage and the protected specimen brush. Am J Med 1988;85:499506.

22. JS Garner , the Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:5380.

23.Hospital Infection Control Advisory Committee. Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995;16:105113.

24. WR McCabe , GG Jackson . Gram negative bacteremia: etiology and ecology. Arch Intern Med 1962;110:847852.

26. WA Knaus , EA Draper , DP Wagner , JE Zimmerman . APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818829.

27. AR Keene , DJ Cullen . Therapeutic Intervention Scoring System. Crit Care Med 1983;11:13.

30. O Lyytikäinen , S Köljalg , M Härmä , J Vuopio-Varkila . Outbreak caused by two multiresistant Acinetobacter baumannii clones in a burns unit: emergence of resistance to imipenem. J Hosp Infect 1995;31:4154.

31. ASS Levin , CMF Mendes , SI Sinto , HS Sader , CRM Scarpitta , E Rodrigues , et al. An outbreak of multiresistant Acinetobacter baumannii in a university hospital in Sao Paulo, Brazil. Infect Control Hosp Epidemiol 1996;17:366368.

32. SL Rosenthal . Sources of Pseudomonas and Acinetobacter species found in human culture materials. Am J Clin Pathol 1974;62:807811.

35. PM Arnow , PA Allyn , EM Nichols , DL Hill , M Pezzlo , RH Bartlett . Control of methicillin-resistant Staphylococcus aureus in a burn unit: role of nurse staffing. J Trauma 1982;22:954958.

36. SK Fridkin , SM Pear , TH Williamson , JN Galgiani , WR Jarvis . The role of understaffing in central venous catheter-associated bloodstream infection. Infect Control Hosp Epidemiol 1996;17:150158.

37. WR Jarvis , JR Edwards , DH Culver , JM Hughes , T Horan , TG Emori , et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 1991;91(suppl 3B):S185S192.

38. NJM Bonten , S Slaughter , AW Ambergen , MK Hayden , J Van Voorhis , C Nathan , et al. The role of colonization pressure in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 1998;158:11271132.

40. DJ Cullen , JM Civetta , BA Briggs , LC Ferrara . Therapeutic Intervention Scoring System: a method for quantitative comparison of patient care. Crit Care Med 1974;2:5760.

41. RD Miranda , R Moreno , G Iapichino . Nine equivalents of nursing manpower use score. Intens Care Med 1997;23:760765.

42. J Mälstam , L Lindt . Therapeutic Intervention Scoring System (TTSS)—a method for measuring workload and calculating costs in the ICU. Acta Anaesthesiol Scand 1992;36:758763.

43. RW Haley , NB Cushion , FC Tenover , TL Bannerman , D Dryer , J Ross , et al. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995;171:614624.

44. E Girou , F Stephan , A Novara , M Safar , JY Fagon . Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients. Am J Respir Crit Care Med 1998;157:11511158.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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