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Outbreak of a multiply resistant Acinetobacter in a surgical intensive care unit: epidemiology and control
Abstract:
During January, 1976 seven patients in an SICU became colonized or infected with Acinetobacter calcoaceticus (variation, anitratum) at an attack rate of 12.5 per cent. The organism showed a marked reduction in antimicrobial sensitivity from previous experience. Comparison with 34 uninfected control patients indicated that intubation and continuous ventilatory assistance were significantly associated with acquiring the organism (p = 0.0154). Acinetobacter was cultured from nurses' hands, AMBU adaptors, respirator apparatus, respirometers, and unlabeled bottles of saline used for tracheal irrigation. Control measures were designed to interrupt transmission. The investigation identified the nursing techniques and reservoirs that allowed this outbreak to occur, and we emphasize the need for close surveillance of patient care procedures in an intensive care unit.
Insights
Acinetobacter calcoaceticus outbreaks in an SICU were linked to intubation and ventilation. Transmission occurred via contaminated equipment and nursing practices, highlighting the need for enhanced surveillance.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Acinetobacter calcoaceticus (anitratum) outbreaks pose a significant threat in intensive care settings.
- Previous experience indicated varying antimicrobial sensitivity patterns for this organism.
Purpose of the Study:
- To investigate an outbreak of Acinetobacter calcoaceticus in a surgical intensive care unit (SICU).
- To identify risk factors and transmission routes associated with the outbreak.
- To inform control measures and surveillance strategies.
Main Methods:
- Retrospective case-control study comparing infected/colonized patients with uninfected controls.
- Microbial culturing from patient samples and environmental sources.
- Analysis of patient care procedures and nursing techniques.
Main Results:
- An attack rate of 12.5% was observed in the SICU during January 1976.
- Intubation and continuous ventilatory assistance were significantly associated with acquiring Acinetobacter (p = 0.0154).
- The organism was cultured from nurses' hands and various respiratory equipment, including AMBU adaptors and saline bottles.
Conclusions:
- The outbreak was linked to specific nursing techniques and environmental reservoirs.
- Close surveillance of patient care procedures in ICUs is crucial for preventing such outbreaks.
- Reduced antimicrobial sensitivity of the organism complicated management.