An outbreak of multidrug-resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment
Lisa L Maragakis1, Sara E Cosgrove, Xiaoyan Song
1Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md, USA. lmaraga1@jhmi.edu
Context:
Pulsatile lavage is a high-pressure irrigation treatment used increasingly in a variety of health care settings to debride wounds. Infection control precautions are not routinely used during the procedure and are not included in pulsatile lavage equipment package labeling.
Objectives:
To investigate an outbreak of multidrug-resistant Acinetobacter baumannii and to test the hypothesis that pulsatile lavage wound treatment was the mode of transmission for the organism.
Design:
Outbreak case-control investigation including case identification, review of medical records, environmental cultures, and pulsed-field gel electrophoresis.
Setting:
A 1000-bed tertiary care hospital in Baltimore, Md, during September and October 2003.
Patients:
The investigation included 11 patients infected or colonized with multidrug-resistant A baumannii. Seven of these patients met the case definition for the case-control study and were compared with 28 controls randomly selected from a list of inpatients without multidrug-resistant A baumannii who had a wound care consultation.
Main Outcome Measure:
Infection or colonization with multidrug-resistant A baumannii.
Results:
Eleven patients had cultures that grew multidrug-resistant A baumannii during the outbreak period. Of the 10 health care-associated cases, 8 had received pulsatile lavage treatment. One strain of multidrug-resistant A baumannii was recovered from all 6 pulsatile lavage patients who had isolates available for pulsed-field gel electrophoresis analysis and from multiple surfaces in the wound care area. Six of 7 cases (86%) were treated with pulsatile lavage vs 4 of 28 controls (14%) (odds ratio, 36; 95% confidence interval, 2.8-1721; P<.001). These results confirm that pulsatile lavage was a significant risk factor for acquisition of multidrug-resistant A baumannii.
Conclusions:
Transmission was apparently caused by dissemination of multidrug-resistant A baumannii during the pulsatile lavage procedure, resulting in environmental contamination. Appropriate infection control precautions should be used during pulsatile lavage therapy and should be included in pulsatile lavage equipment labeling.
Insights
Pulsatile lavage, a wound treatment, transmitted multidrug-resistant Acinetobacter baumannii during an outbreak. Enhanced infection control measures are crucial for this procedure to prevent environmental contamination and patient spread.
Area of Science:
- Infectious Disease Epidemiology
- Healthcare-Associated Infections
- Wound Care Management
Background:
- Pulsatile lavage is a common high-pressure wound debridement technique.
- Routine infection control precautions are not standard during pulsatile lavage.
- Lack of established protocols may facilitate pathogen transmission.
Purpose of the Study:
- Investigate an outbreak of multidrug-resistant Acinetobacter baumannii (MDRAB).
- Determine if pulsatile lavage was the transmission route for MDRAB.
- Assess the association between pulsatile lavage and MDRAB acquisition.
Main Methods:
- Conducted a case-control investigation during an MDRAB outbreak.
- Included case identification, medical record review, and environmental cultures.
- Utilized pulsed-field gel electrophoresis (PFGE) for strain typing.
Main Results:
- Eight of ten healthcare-associated MDRAB cases received pulsatile lavage.
- Pulsatile lavage was a significant risk factor (OR, 36; P<.001).
- Identical MDRAB strains found in patients and on equipment surfaces.
Conclusions:
- Pulsatile lavage likely transmitted MDRAB, causing environmental contamination.
- Infection control measures are essential during pulsatile lavage.
- Equipment labeling should include infection control guidance.
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