Bed rails and endotracheal tube connectors as possible sources for spreading Acinetobacter baumannii in ventilator-associated pneumonia patients
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Suphawita Chaladchalam1, Pornphan Diraphat, Fuangfa Utrarachkij
1Department of Microbiology, Faculty of Public Health, Mahidol University, 420/1 Ratchawithi Road, Bangkok 10400, Thailand.
Abstract:
This study aimed to determine molecular patterns of Acinetobacter baumannii using a PCR-based technique with REP-1, REP-2 and M13 primers to distinguish the patients' strains and the environmental strains (condensate, endotracheal tube connector, bed rail and nurses hands). There were 67 cases of ventilator-associated pneumonia (VAP) among 600 patients using mechanical ventilators in 10 wards from March to July 2006. The incidence of VAP was 11.2% or 8.9/1,000 ventilator days with a 54.5% fatality rate. Among 19 of 22 A. baumannii VAP patients, 68.4% (13/19) had their environmental samples contaminated with A. baumannii and the most common contaminated sites were bed rails and endotracheal tube connectors (36.8% each). Multidrug resistant (MDR) A. baumannii were involved in 77.3% of A. baumannii VAP. Molecular typing of 96 A. baumannii isolates was able to differentiate A. baumannii isolates into 7 types. Type 2 was the most common and found in 77.3% (17/22) of A. baumannii VAP patients admitted in 6 of 7 wards. Identical fingerprints were found in clinical isolates and their bed rails, endotracheal tube connectors and condensates of 5 patients. The results demonstrate that multiple clones of MDR A. baumannii were widely spread in the hospital. Bed rails and contaminated endotracheal tube connectors could be potential sources of A. baumannii spread.
Insights
This study identified multiple strains of multidrug-resistant Acinetobacter baumannii spreading within a hospital. Bed rails and endotracheal tube connectors were key sources of Acinetobacter baumannii contamination, highlighting infection control challenges.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Molecular Epidemiology
Background:
- Acinetobacter baumannii is a significant cause of hospital-acquired infections, particularly ventilator-associated pneumonia (VAP).
- Multidrug resistance (MDR) in Acinetobacter baumannii complicates treatment and increases patient mortality.
- Understanding the transmission dynamics of Acinetobacter baumannii within healthcare settings is crucial for effective infection control.
Purpose of the Study:
- To determine the molecular patterns of Acinetobacter baumannii strains isolated from patients and the hospital environment.
- To investigate the sources and transmission routes of Acinetobacter baumannii contributing to VAP.
- To assess the prevalence of multidrug-resistant Acinetobacter baumannii in a hospital setting.
Main Methods:
- Polymerase chain reaction (PCR) with REP-1, REP-2, and M13 primers was used for molecular typing of Acinetobacter baumannii isolates.
- Environmental samples (condensate, endotracheal tube connectors, bed rails, nurses' hands) and clinical samples were collected.
- Ventilator-associated pneumonia (VAP) incidence and fatality rates were recorded.
Main Results:
- Acinetobacter baumannii was identified as a major pathogen in VAP cases, with a high fatality rate (54.5%).
- Multidrug-resistant (MDR) Acinetobacter baumannii accounted for 77.3% of VAP cases.
- Molecular typing revealed 7 distinct Acinetobacter baumannii types, with Type 2 being the most prevalent.
- Environmental contamination was common, with bed rails and endotracheal tube connectors frequently implicated (36.8% each).
- Identical molecular fingerprints were observed between clinical isolates and environmental samples from the same patients.
Conclusions:
- Multiple clones of MDR Acinetobacter baumannii are widely disseminated within the hospital environment.
- Bed rails and contaminated endotracheal tube connectors serve as significant reservoirs for Acinetobacter baumannii transmission.
- Enhanced environmental cleaning and disinfection protocols are necessary to control Acinetobacter baumannii spread.
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