Protracted outbreak of multidrug-resistant Acinetobacter baumannii after intercontinental transfer of colonized
Caroline Landelle1, Patrick Legrand, Philippe Lesprit
1Unité de Contrôle, Epidémiologie et Prévention de l'Infection, Centre Hospitalier Universitaire Albert Chenevier-Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris 12, Créteil, France. caroline.landelle@gmail.com
Objective:
To describe the course and management of a protracted outbreak after intercontinental transfer of 2 patients colonized with multidrug-resistant Acinetobacter baumannii (MDRAB).
Design:
An 18-month outbreak investigation.
Setting:
An 860-bed university hospital in France.
Patients:
Case patients (ie, carriers) were those colonized or infected with an MDRAB isolate.
Methods:
During the epidemic period, all intensive care unit (ICU) patients and contacts of carriers who were transferred to wards were screened for MDRAB carriage. Contact precautions, environmental screening, and auditing of healthcare worker (HCW) practices were implemented; rooms were cleaned with hydrogen peroxide mist disinfection. One ICU, in which most of the cases occurred, was closed on 4 occasions for thorough cleaning and disinfection.
Results:
The 2 index case patients were identified as 2 patients who carried the same MDRAB strain and who were admitted to the hospital after repatriation from Tahiti 5 months apart. During an 18-month period, a total of 84 secondary cases occurred. Reintroduction of MDRAB into the ICUs occurred from patients previously colonized or from healthcare personnel. Termination of the outbreak was only achieved when all carriers from wards or the ICU were cohorted to an isolation unit with dedicated healthcare personnel.
Conclusions:
Intercontinental transfer of carriers of MDRAB can result in extensive outbreaks and serious disruption of the hospital's organization. Transmission from carriers most likely occurred via the hands of HCWs, poor cleaning protocols, airborne spread, and contaminated water from sink traps. This protracted outbreak was controlled only after implementation of an extensive control program and eventual cohorting of all carriers in an isolation unit with dedicated healthcare personnel.
Insights
Intercontinental transfer of patients carrying multidrug-resistant Acinetobacter baumannii (MDRAB) can cause prolonged hospital outbreaks. Effective control required rigorous measures, including cohorting infected patients with dedicated staff.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Microbiology
Background:
- Multidrug-resistant Acinetobacter baumannii (MDRAB) poses a significant threat in healthcare settings.
- Intercontinental patient transfer can introduce resistant pathogens, leading to complex outbreaks.
- Protracted outbreaks necessitate comprehensive investigation and management strategies.
Purpose of the Study:
- To describe the course and management of a prolonged MDRAB outbreak.
- To identify transmission routes and contributing factors.
- To evaluate control measures for MDRAB spread.
Main Methods:
- An 18-month outbreak investigation in an 860-bed university hospital.
- Screening of intensive care unit (ICU) patients and ward contacts.
- Implementation of contact precautions, environmental cleaning (hydrogen peroxide mist), and HCW audits.
- Temporary closure and disinfection of an ICU.
- Cohorting of MDRAB carriers in an isolation unit.
Main Results:
- Two index cases of MDRAB colonization were identified following intercontinental transfer.
- An 18-month period resulted in 84 secondary cases of MDRAB.
- MDRAB reintroduction occurred from colonized patients and healthcare personnel.
- The outbreak was controlled after implementing cohorting of all carriers.
Conclusions:
- Intercontinental transfer of MDRAB carriers can initiate extensive and disruptive hospital outbreaks.
- Transmission pathways included HCW hands, inadequate cleaning, airborne spread, and contaminated water.
- Effective control required a comprehensive program, culminating in dedicated isolation for carriers.
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