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Epidemic bacteremia due to Acinetobacter baumannii in five intensive care units
C M Beck-Sagué1, W R Jarvis, J H Brook
1Hospital Infections Program, Centers for Disease Control, Atlanta, GA 30333.
Abstract:
From March 5, 1986 to September 4, 1987, Acinetobacter baumannii (AB) was isolated from blood or vascular catheter-tip cultures of 75 patients in five intensive care units at a hospital in New Jersey. To identify risk factors for AB bacteremia in the intensive care units, a case-control study was conducted. Characteristics of 72 case-patients were compared with those of 37 controls. Case-patients were more likely than controls to have had peripheral arterial catheters (odds ratio (OR) = 7.0, p less than 0.001), mechanical ventilation (OR = 5.8, p less than 0.001), hyperalimentation (OR = 5.7, p less than 0.001), or pulmonary arterial catheters (OR = 3.9, p less than 0.001). Arterial catheters were used with reusable pressure transducers for intravascular pressure monitoring. A logistic regression analysis identified four independent risk factors: transducers, ventilation, hyperalimentation, and days of transducer use at an insertion site. The strongest influence on the risk of AB bacteremia was exerted by number of days of transducer usage. Cultures of 70 transducer diaphragms or domes, 42 in-use and 28 in-storage, were positive for AB in 21% and 46%, respectively. Plasmid analysis showed that patient blood cultures and transducer isolates were identical. Transducers were wiped with alcohol in the units between patient uses. Since reusable transducers appeared to be the source of this outbreak, it is recommended that reusable transducers receive either high level disinfection or sterilization between patient uses.
Insights
Reusable transducers in intensive care units were linked to Acinetobacter baumannii bacteremia outbreaks. Reducing transducer use days and implementing high-level disinfection or sterilization are key prevention strategies.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Hospital Epidemiology
Background:
- Acinetobacter baumannii (AB) bacteremia is a significant concern in intensive care units (ICUs).
- Identifying the sources and risk factors for AB bacteremia is crucial for effective infection control.
Purpose of the Study:
- To identify risk factors associated with Acinetobacter baumannii bacteremia in ICU patients.
- To investigate the role of reusable pressure transducers in the transmission of AB.
Main Methods:
- A case-control study comparing 72 case-patients with 37 controls was conducted.
- Logistic regression analysis was used to identify independent risk factors for AB bacteremia.
- Cultures of reusable pressure transducer diaphragms/domes were analyzed for AB contamination.
Main Results:
- Peripheral arterial catheters, mechanical ventilation, hyperalimentation, and pulmonary arterial catheters were associated with increased risk.
- Reusable transducers, particularly the number of days of use, emerged as a significant independent risk factor.
- Acinetobacter baumannii was detected in 21% of in-use and 46% of stored transducer cultures, with identical plasmid profiles to patient isolates.
Conclusions:
- Reusable pressure transducers represent a potential source for Acinetobacter baumannii transmission in ICUs.
- Recommendations include limiting the duration of transducer use and implementing stringent disinfection or sterilization protocols for reusable transducers.