An outbreak of multi-drug-resistant Acinetobacter baumannii on a burns ICU and its control with multi-faceted
T Obenhuber1, T C Scheier1, T Stutz1
1Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Background:
Patients in burns centres are at high risk of acquiring multi-drug-resistant organisms (MDROs) due to the reduced skin barrier and long hospital stay.
Methods:
This study reports the investigation and control of an outbreak of MDR Acinetobacter baumannii in a burns centre. The 27 patients hospitalized in the centre during the outbreak were screened regularly, and a total of 132 environmental samples were analysed to identify a potential source. Fourier-transform infra-red (FT-IR) spectroscopy and multi-locus sequence typing were applied to characterize the outbreak strain.
Results:
Between August and November 2022, the outbreak affected eight patients, with 11 infections and three potentially related fatal outcomes. An interdisciplinary and multi-professional outbreak team implemented a bundle strategy with repetitive admission stops, isolation precaution measures, patient screenings, enhanced cleaning and disinfection, and staff education. FT-IR spectroscopy suggested that the outbreak started from a patient who had been repatriated 1 month previously from a country with high prevalence of MDR A. baumannii. Environmental sampling did not identify a common source. Acquisition of the outbreak strain was associated with a higher percentage of body surface area with burn lesions ≥2a [per percent increase: odds ratio (OR) 1.05, 95% confidence interval (CI) 0.99-1.12; P=0.09], and inversely associated with a higher nurse-to-patient ratio (per 0.1 increase: OR 0.34, 95% CI 0.10-1.12; P=0.06).
Conclusions:
Burn patients with a higher percentage of body surface area with burn lesions ≥2a are at high risk of colonization and infection due to MDROs, particularly during periods of high workload. A multi-faceted containment strategy can successfully control outbreaks due to MDR A. baumannii in a burns centre.
Insights
Multi-drug-resistant organism (MDRO) outbreaks in burn centers pose significant risks. A comprehensive strategy involving infection control measures and staff education effectively controlled a multi-drug-resistant Acinetobacter baumannii outbreak.
Area of Science:
- Infectious Disease Epidemiology
- Critical Care Medicine
- Public Health Microbiology
Background:
- Patients in burn centers face elevated risks of multi-drug-resistant organism (MDRO) acquisition due to compromised skin barriers and prolonged hospital stays.
- The study addresses the critical issue of MDRO transmission in vulnerable burn patient populations.
Purpose of the Study:
- To investigate and control an outbreak of multi-drug-resistant Acinetobacter baumannii within a specialized burns center.
- To identify risk factors associated with MDRO acquisition in burn patients during an outbreak.
Main Methods:
- Regular screening of hospitalized patients and environmental sampling to detect MDRO presence.
- Utilized Fourier-transform infra-red (FT-IR) spectroscopy and multi-locus sequence typing for strain characterization.
- Implemented a multi-faceted containment strategy including admission control, isolation, enhanced disinfection, and staff education.
Main Results:
- An outbreak of multi-drug-resistant Acinetobacter baumannii occurred between August and November 2022, affecting eight patients with 11 infections and three fatalities.
- Increased burn surface area (≥2a) was associated with higher acquisition risk, while a higher nurse-to-patient ratio showed a protective effect.
- Environmental sampling did not pinpoint a single common source, suggesting complex transmission dynamics.
Conclusions:
- Burn patients with extensive burn lesions (≥2a) are particularly susceptible to MDRO colonization and infection, especially during high-workload periods.
- A coordinated, multi-disciplinary containment strategy is highly effective in controlling outbreaks of multi-drug-resistant Acinetobacter baumannii in burns units.
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