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

Published online by Cambridge University Press:  02 January 2015

Lisiane Fierobe ,
Jean-Christophe Lucet ,
Dominique Decré ,
Claudette Muller-Serieys ,
Arnaud Deleuze ,
Marie-Laure Joly-Guillou ,
Jean Mantz  and
Jean-Marie Desmonts
Lisiane Fierobe*
Affiliation:
Department of Anesthesiology and Intensive Care, Bichat-Claude Bernard University Hospital, Paris, France
Jean-Christophe Lucet
Affiliation:
Infection Control Unit, Bichat-Claude Bernard University Hospital, Paris, France
Dominique Decré
Affiliation:
Department of Microbiology, Bichat-Claude Bernard University Hospital, Paris, France
Claudette Muller-Serieys
Affiliation:
Department of Microbiology, Bichat-Claude Bernard University Hospital, Paris, France
Arnaud Deleuze
Affiliation:
Department of Anesthesiology and Intensive Care, Bichat-Claude Bernard University Hospital, Paris, France
Marie-Laure Joly-Guillou
Affiliation:
Department of Microbiology, Bichat-Claude Bernard University Hospital, Paris, France
Jean Mantz
Affiliation:
Department of Anesthesiology and Intensive Care, Bichat-Claude Bernard University Hospital, Paris, France
Jean-Marie Desmonts
Affiliation:
Department of Anesthesiology and Intensive Care, Bichat-Claude Bernard University Hospital, Paris, France
*
Department of Anesthesiology and Intensive Care, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75018 Paris, France
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Abstract

Objective:

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 1 , January 2001 , pp. 35 - 40
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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References

1.Cisneros, JM, Reyes, MJ, Paction, J, Becerril, B, Caballero, FJ, Garcia-Garmendia, JL, et al. Bacteremia due to Acinetobacter baumannii: epidemiology, clinical findings, and prognostic features. Clin Infect Dis 1996;22:1026–1032.CrossRefGoogle ScholarPubMed
2.Urban, C, Go, E, Mariano, N, Berger, BJ, Avraham, I, Rubin, D, et al. Effect of sulbactam on infections caused by imipenem-resistant Acinetobacter calcoaceticus biotype anitratus. J Infect Dis 1993;167:448–451.CrossRefGoogle ScholarPubMed
3.Kaul, R, Burt, JA, Cork, L, Dedier, H, Garcia, M, Kennedy, C, 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;174:1279–1287.CrossRefGoogle ScholarPubMed
4.Contant, J, Kemeny, E, Oxley, C, Perry, E, Garber, G. Investigation of an outbreak of Acinetobacter calcoaceticus var anitratus infections in an adult intensive care unit. Am J Infect Control 1990;18:288–291.CrossRefGoogle Scholar
5.Go, ES, Urban, C, Burns, J, Kreiswirth, B, Eisner, W, Mariano, N, et al. Clinical and molecular epidemiology of Acinetobacter infections sensitive only to polymyxin B and sulbactam. Lancet 1994;344:1329–1332.CrossRefGoogle ScholarPubMed
6.Scerpella, EG, Wanger, AR, Armitige, L, Anderlini, P, Erisson, 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.CrossRefGoogle ScholarPubMed
7.Lortholary, O, Fagon, JY, Buu Hoi, A, Slama, MA, Pierre, J, Giral, P, et al. Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis. Clin Infect Dis 1995;20:790–796.CrossRefGoogle ScholarPubMed
8.Ayats, J, Corbella, X, Ardanuy, C, Dominguez, MA, Ricart, A, Ariza, J, et al. Epidemiological significance of cutaneous, pharyngeal, and digestive tract colonization by multiresistant Acinetobacter baumannii in ICU patients. J Hosp Infect 1997;37:287–295.CrossRefGoogle ScholarPubMed
9.Mulin, B, Talon, D, Viel, JF, Vincent, C, Leprat, R, Thouverez, M, et al. Risk factors for nosocomial colonization with multiresistant Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis 1995;14:569–576.CrossRefGoogle ScholarPubMed
10.Taplin, D, Rebell, G, Zaias, N. The human skin as a source of Mima Herellea infections. JAMA 1963;186:952–955.CrossRefGoogle ScholarPubMed
11.Rosenthal, S, Tager, IB. Prevalence of gram negative rods in the normal pharyngeal flora. Ann Intern Med 1975;83:355–357.CrossRefGoogle ScholarPubMed
12.Corbella, X, Pujol, M, Ayats, J, Sendra, M, Ardanuy, C, Dominguez, MA, et al. Relevance of digestive tract colonization in the epidemiology of nosocomial infections due to multiresistant Acinetobacter baumannii. Clin Infect Dis 1996;23:329–333.CrossRefGoogle ScholarPubMed
13.Timsit, JF, Garrait, V, Misset, B, Goldstein, FW, Renaud, B, Carlet, J. The digestive tract is a major site for Acinetobacter baumannii colonization in intensive care unit patients. J Infect Dis 1993;168:1336–1337.CrossRefGoogle Scholar
14.Hartstein, AJ, Rashad, AI, Liebler, JM, Actis, LA, Freeman, J, Rourke, JW, 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;85:624–631.CrossRefGoogle ScholarPubMed
15.Gervich, DH, Grout, CS. An outbreak of nosocomial Acinetobacter infections from humidifiers. Am J Infect Control 1985;13:210–215.CrossRefGoogle ScholarPubMed
16.Villers, D, Espaze, E, Coste-Burel, M, Giauffret, F, Ninin, E, Nicolas, F, et al. Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med 1998;129:182–189.CrossRefGoogle ScholarPubMed
17.Gouby, A, Carles-Nurrit, MJ, Bouzigues, N, Bourg, G, Mesnard, R, Bouvet, PJ. Use of pulsed-field gel electrophoresis for investigation of hospital outbreaks of Acinetobacter baumannii. J Clin Microbiol 1992;30:1588–1591.CrossRefGoogle ScholarPubMed
18.Garner, JS, Jarvis, WR, Emory, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
19.Chastre, J, Fagon, JY, Soler, P, Bornet, M, Domart, Y, Trouillet, JL, 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;85:499–506.CrossRefGoogle ScholarPubMed
20.Brun-Buisson, C, Abrouk, F, Legrand, P, Huet, Y, Larabi, S, Rapin, M. Diagnosis of central venous catheter-related sepsis: critical level of quantitative tip cultures. Arch Intern Med 1987;47:873–877.CrossRefGoogle Scholar
21.Pickett, MJ, Hollis, DG, Bottone, EJ. Miscellaneous gram-negative bacteria. In: Balows, A, Hausler, WJ, Herrmann, KL, Isenberg, HD, Shadomy, HJ, eds. Manual of Clinical Microbiology. 5th ed. Washington, DC: American Society for Microbiology; 1991:410–428.Google Scholar
22.Garner, JS, the Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53–80.CrossRefGoogle ScholarPubMed
23.Hospital Infection Control Advisory Committee. Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995;16:105–113.CrossRefGoogle Scholar
24.McCabe, WR, Jackson, GG. Gram negative bacteremia: etiology and ecology. Arch Intern Med 1962;110:847–852.CrossRefGoogle Scholar
25.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. Prognosis in acute organ-system failure. Ann Surg 1985;11:685–693.CrossRefGoogle Scholar
26.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.CrossRefGoogle ScholarPubMed
27.Keene, AR, Cullen, DJ. Therapeutic Intervention Scoring System. Crit Care Med 1983;11:1–3.CrossRefGoogle ScholarPubMed
28.Tankovic, J, Legrand, P, De Gatines, G, Chemineau, V, Brun-Buisson, C, Duval, J. Characterization of a hospital outbreak of imipenem resistant Acinetobacter baumannii by phenotypic and genotypic methods. J Clin Microbiol 1994;32:2677–2681.CrossRefGoogle Scholar
29.Dijkshoorn, L, Aucken, H, Gerner-Smidt, P, Janssen, P, Kaufmann, ME, Garaizar, J, et al. Comparison of outbreak and non-outbreak Acinetobacter baumannii strains by genotypic and phenotypic methods. J Clin Microbiol 1996;34:1519–1525.CrossRefGoogle Scholar
30.Lyytikäinen, O, Köljalg, S, Härmä, M, Vuopio-Varkila, J. Outbreak caused by two multiresistant Acinetobacter baumannii clones in a burns unit: emergence of resistance to imipenem. J Hosp Infect 1995;31:41–54.CrossRefGoogle Scholar
31.Levin, ASS, Mendes, CMF, Sinto, SI, Sader, HS, Scarpitta, CRM, Rodrigues, E, et al. An outbreak of multiresistant Acinetobacter baumannii in a university hospital in Sao Paulo, Brazil. Infect Control Hosp Epidemiol 1996;17:366–368.CrossRefGoogle Scholar
32.Rosenthal, SL. Sources of Pseudomonas and Acinetobacter species found in human culture materials. Am J Clin Pathol 1974;62:807–811.CrossRefGoogle ScholarPubMed
33.Beck-Sagué, CM, Jarvis, WR, Brook, JH, Culver, DH, Potts, A, Gay, E, et al. Epidemic bacteremia due to Acinetobacter baumannii in five intensive care units. Am J Epidemiol 1990;132:723–733.CrossRefGoogle ScholarPubMed
34.Joly-Guillou, ML, Brun-Buisson, C. Epidemiology of Acinetobacter. surveillance and management of outbreaks. In: Bergogne-Berezin, E, Joly-Guillou, ML, Towner, KJ, eds. Acinetobacter, Microbiology, Epidemiology, Infections and Management. London, UK: CRC Press; 1996:71–100.Google Scholar
35.Arnow, PM, Allyn, PA, Nichols, EM, Hill, DL, Pezzlo, M, Bartlett, RH. Control of methicillin-resistant Staphylococcus aureus in a burn unit: role of nurse staffing. J Trauma 1982;22:954–958.CrossRefGoogle Scholar
36.Fridkin, SK, Pear, SM, Williamson, TH, Galgiani, JN, Jarvis, WR. The role of understaffing in central venous catheter-associated bloodstream infection. Infect Control Hosp Epidemiol 1996;17:150–158.Google Scholar
37.Jarvis, WR, Edwards, JR, Culver, DH, Hughes, JM, Horan, T, Emori, TG, et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 1991;91(suppl 3B):S185–S192.CrossRefGoogle ScholarPubMed
38.Bonten, NJM, Slaughter, S, Ambergen, AW, Hayden, MK, Van Voorhis, J, Nathan, C, et al. The role of colonization pressure in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 1998;158:1127–1132.CrossRefGoogle ScholarPubMed
39.Knaus, WA, Legall, JR, Wagner, DP, Loirat, P, Cullen, DJ, Glaser, P, et al. A comparison of intensive care in the USA and France. Lancet 1982;2:642–646.CrossRefGoogle ScholarPubMed
40.Cullen, DJ, Civetta, JM, Briggs, BA, Ferrara, LC. Therapeutic Intervention Scoring System: a method for quantitative comparison of patient care. Crit Care Med 1974;2:57–60.CrossRefGoogle ScholarPubMed
41.Miranda, RD, Moreno, R, Iapichino, G. Nine equivalents of nursing manpower use score. Intens Care Med 1997;23:760–765.CrossRefGoogle Scholar
42.Mälstam, J, Lindt, L. Therapeutic Intervention Scoring System (TTSS)—a method for measuring workload and calculating costs in the ICU. Acta Anaesthesiol Scand 1992;36:758–763.CrossRefGoogle Scholar
43.Haley, RW, Cushion, NB, Tenover, FC, Bannerman, TL, Dryer, D, Ross, J, et al. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995;171:614–624.CrossRefGoogle ScholarPubMed
44.Girou, E, Stephan, F, Novara, A, Safar, M, Fagon, JY. Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients. Am J Respir Crit Care Med 1998;157:1151–1158.CrossRefGoogle ScholarPubMed