Control of a multidrug-resistant Acinetobacter baumannii outbreak

This article describes the management of an outbreak of multidrug-resistant Acinetobacter baumannii (MDR-Ab) at an acute NHS Foundation Trust. The outbreak affected two respiratory wards and the initial outbreak lasted 9 months, with the first patient (index case) being identified in April 2015 and the final, tenth case, in September 2015. The outbreak was declared closed in January 2016, but a further two cases were identified in July and August 2016. Of the 12 identified patients, eight were colonised with the bacterium and four were infected. The four infections were of the respiratory tract with MDR-Ab, of identical variable number tandem repeat, isolated from sputum in all cases. All 12 patients were decolonised and this continued throughout the outbreak. Some negative rescreening results were achieved. At the time of the outbreak, decolonisation using octenidine had not been reported in any guidelines. The sensitivity of MDR-Ab to octenidine was microbiologically tested and antibacterial action of octenidine against this organism was demonstrated. The use of octenidine appeared to be one element in helping to control this testing situation. This report seeks to demonstrate not only the complexity of managing and containing an outbreak of MDR-Ab but also how, with the use of a range of effective infection prevention measures, the spread of this pathogen can be successfully controlled. It is hoped that this article will increase awareness among healthcare providers and infection prevention and control (IPC) teams of the threat posed by this organism in the healthcare environment.