Two consecutive outbreaks of Acinetobacter baumanii 1-a in a burn Intensive Care Unit for adults
R Herruzo1, J de la Cruz, M J Fernández-Aceñero
1Department of Preventive Medicine UAM, Autonoma University of Madrid and Hospital La Paz, C/Arzobispo Morcillo, 4, 28029 Madrid, Spain. rafael.herruzo@uam.es
Unlabelled:
Acinetobacter baumanii is generally a highly antibiotic resistant micro-organism that can be easily transmitted between inpatients of ICUs. We report two consecutive outbreaks of A. baumanii in a burn ICU.
Material And Methods:
All patients with ICU-stay greater than 2 days were subject to a strict epidemiological surveillance after admission, recording age, sex, TSBA, etc. and follow-up data such as antibiotherapy, instrumentation, infections, etc. We also monitored the microbial flora evolution and their resistance to antibiotic by weekly cultures of pharynx, rectum, skin (healthy and burned), etc. Because of an "epidemic" microorganism, infection control procedures, were increased. We studied the colonization by other prevalent microorganisms: MR-S. aureus and Pseudomonas aeruginosa.
Results:
Seventy-two burn patients were followed in 1 year. Only 4.1% were infected at some site by A. baumanii, but 1/3 of patients were colonized by this microorganism, distributed in two outbreaks, one in the first trimester, after admission in the Unit of two non-burned and colonized patients (from another ICU). The second epidemic began in July and probably was due to transitory colonization of skin or fomites by health personnel working in both ICUs. All the isolates (from both ICUs) of A. baumanii were identical by PFGE. The length of hospital stay was the main risk factor for colonization. P. aeruginosa and MR-S. aureus showed a tendency to be endemo-epidemic at all times.
Conclusion:
Our cross colonization control measures showed a limited efficacy our burn patients. Therefore, we must impede the introduction to burn ICUs of epidemic microorganisms by colonized patients or heath personnel by restriction of admission of A. baumanii colonized patients from other ICUs (if the treatment can be administered in this ICU) and by strict disinfection/antiseptic procedures.
Insights
Two Acinetobacter baumanii outbreaks occurred in a burn ICU, highlighting limited efficacy of control measures. Preventing introduction of colonized patients and staff hygiene are crucial for burn intensive care units.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Acinetobacter baumanii is a highly antibiotic-resistant pathogen frequently transmitted in intensive care units (ICUs).
- Burn ICUs are particularly vulnerable to the spread of multidrug-resistant organisms due to patient susceptibility and prolonged stays.
Purpose of the Study:
- To report and analyze two consecutive outbreaks of Acinetobacter baumanii in a specialized burn intensive care unit.
- To investigate the epidemiology, risk factors, and control measure efficacy for Acinetobacter baumanii colonization and infection in burn patients.
Main Methods:
- Prospective epidemiological surveillance of burn patients admitted to the ICU, recording clinical data and microbial flora.
- Weekly cultures of pharyngeal, rectal, and skin sites to monitor microbial evolution and antibiotic resistance.
- Enhanced infection control procedures implemented due to the identification of an 'epidemic' microorganism.
Main Results:
- During a 1-year period, 4.1% of 72 burn patients were infected by Acinetobacter baumanii, while one-third were colonized.
- Two distinct outbreaks were identified, linked to the admission of colonized patients and potential transmission by healthcare personnel.
- Patient length of hospital stay was identified as the primary risk factor for Acinetobacter baumanii colonization.
Conclusions:
- Standard cross-colonization control measures demonstrated limited effectiveness in preventing Acinetobacter baumanii spread in this burn ICU.
- Strict protocols are necessary to prevent the introduction of epidemic microorganisms, including restricting admission of colonized patients and rigorous disinfection.
- Controlling Acinetobacter baumanii outbreaks requires a multi-faceted approach focusing on source control and enhanced preventive strategies.
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