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Rapid and Specific Detection of Acinetobacter baumannii Infections Using a Recombinase Polymerase Amplification/Cas12a-based System
Published on: April 25, 2025
The Bad Bug is Back: Acinetobacter Baumannii Bacteremia Outbreak during the COVID-19 Pandemic in an Intensive Care
1Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey.
Background:
Epidemiology of nosocomial infections may show variability because of under-estimation of infection control measures (ICMs) in coronavirus disease 19 (COVID-19) outbreak.
Aim:
To investigate the Acinetobacter bacteremia outbreak developed in an intensive care unit (ICU) between March 20 to May 15, 2020, examine the risk factors, and re-evaluate ICM retrospectively.
Material And Methods:
A retrospective cohort analysis was conducted to determine the risk factors, pulsed field gel electrophoresis (PFGE) was performed for analysis of the outbreak, ICM practices were observed by a team, and infection control interventions were undertaken.
Results:
Acinetobacter bacteremia developed in 17 patients (21.5%) within 79 COVID-19 patients included in the study. The mean age of the bacteremic patients was 67.3 (SD = 14.82) years, and 82.4% of them were male; of these, 15 died, leading to 88.2% mortality. The bacteremia rate was higher compared with a 14-month period preceding the COVID-19 pandemic (17/79 versus 12/580 patients, respectively). PFGE revealed that the outbreak was polyclonal. On multi-variate analysis, the bacteremia development rate was 13.7 and 5.06 times higher with central venous catheter (CVC) use and in patients with chronic obstructive pulmonary disease (COPD), respectively. The mortality rate was higher in bacteremic patients (p = 0.0016). It was observed that ICMs were not followed completely, especially change of gloves and hand hygiene. Contamination of A. baumannii was observed in 38% of the gloves.
Conclusion:
COPD and CVC use were determined as risk factors for Acinetobacter bacteremia development, and failures in ICM may have led to cross-contamination of endemic A. baumannii. The outbreak could be controlled within 3 weeks of interventions.
Insights
Acinetobacter bacteremia outbreaks in COVID-19 patients were linked to central venous catheters and COPD. Inconsistent infection control measures, like poor hand hygiene, contributed to high mortality and spread.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Nosocomial infections can be underestimated during COVID-19 outbreaks due to inconsistent infection control.
- Acinetobacter bacteremia poses a significant threat in intensive care units (ICUs).
Purpose of the Study:
- Investigate an Acinetobacter bacteremia outbreak in an ICU during the COVID-19 pandemic.
- Identify risk factors for Acinetobacter bacteremia.
- Re-evaluate infection control measures (ICMs) retrospectively.
Main Methods:
- Retrospective cohort analysis to identify risk factors.
- Pulsed field gel electrophoresis (PFGE) for outbreak strain analysis.
- Direct observation of ICM practices and implementation of interventions.
Main Results:
- Acinetobacter bacteremia occurred in 21.5% of 79 COVID-19 patients, with 88.2% mortality.
- Central venous catheter use (OR=13.7) and COPD (OR=5.06) were significant risk factors.
- Incomplete adherence to ICMs, including hand hygiene and glove changes, was observed, with A. baumannii contamination on 38% of gloves.
Conclusions:
- COPD and CVC use are key risk factors for Acinetobacter bacteremia.
- Deficiencies in ICMs likely facilitated cross-contamination and the outbreak.
- Interventions successfully controlled the outbreak within three weeks.
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