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Extensively drug-resistant Acinetobacter baumannii outbreak cross-transmitted in an intensive care unit and
Jin'e Lei1, Shaoshan Han2, Wenjing Wu3
1Department of Pathogenic Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, China; Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Background:
Extensively drug-resistant Acinetobacter baumannii (XDRAB) is a great threat in intensive care units (ICUs). The aim of this study was to describe an XDRAB outbreak which was cross-transmitted in the ICU and respiratory intensive care unit (RICU) in a tertiary care hospital from January-March 2013.
Methods:
Patient and environmental surveillances were performed. Isolates were tested for antimicrobial susceptibility. Genotypes were analyzed by multilocus sequence typing (MLST). A series of enhanced strategies were implemented to control the outbreak.
Results:
A total of 11 patients were infected by XDRAB strains during this outbreak. Three patients in the ICU were found positive for XDRAB at the onset of the outbreak. Thereafter, infections were detected in 6 patients in the RICU, followed by reappearance of this strain in the ICU in 2 patients. All A baumannii strains isolated from patients and the environment were extensively drug resistant. MLST revealed them as ST368. After 3 rounds of environmental screening and cleaning, the laminar flow system connecting the ICU and RICU was found as the source of transmission. Successful control of this outbreak was achieved through multifaceted intervention measures.
Conclusions:
This study suggested the importance of thorough surveillance and disinfection of the environment, including concealed devices, in preventing the transmission of an outbreak.
Insights
An extensively drug-resistant Acinetobacter baumannii (XDRAB) outbreak spread between ICU and RICU units. Enhanced surveillance and disinfection, targeting a laminar flow system, successfully controlled the XDRAB transmission.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Extensively drug-resistant Acinetobacter baumannii (XDRAB) poses a significant threat in intensive care units (ICUs).
- This study investigated an XDRAB outbreak with cross-transmission between an ICU and a respiratory intensive care unit (RICU).
Observation:
- Eleven patients were infected with XDRAB during the outbreak period (January-March 2013).
- Infections initially appeared in the ICU, spread to the RICU, and then recurred in the ICU.
- Environmental screening identified a laminar flow system connecting the units as the transmission source.
Findings:
- All Acinetobacter baumannii isolates from patients and the environment exhibited extensive drug resistance.
- Multilocus sequence typing (MLST) identified the outbreak strains as ST368.
- Multifaceted intervention measures, including enhanced disinfection, led to successful outbreak control.
Implications:
- Highlights the critical role of comprehensive surveillance in identifying and controlling hospital-acquired infections.
- Emphasizes the need for meticulous environmental disinfection, including often overlooked equipment like laminar flow systems.
- Demonstrates the effectiveness of targeted interventions in managing extensively drug-resistant bacterial outbreaks in critical care settings.
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