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Ventilator-related Acinetobacter outbreak in an intensive care unit
T R Cox1, W E Roland, M E Dolan
1Harry S Truman Memorial Veterans Hospital, Columbia, MO 65201, USA.
Military Medicine
|June 26, 1998
Summary
An outbreak of ciprofloxacin-resistant Acinetobacter baumannii pneumonia in an ICU was controlled by identifying imipenem as the effective treatment. This led to a significant decrease in Acinetobacter infections and no new pneumonia cases.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Acinetobacter baumannii is a significant cause of nosocomial infections, particularly in intensive care units.
- Ciprofloxacin-resistant strains pose a therapeutic challenge, complicating treatment strategies.
- Ventilator-associated pneumonia (VAP) is a common complication in critically ill patients.
Purpose of the Study:
- To investigate an outbreak of ciprofloxacin-resistant Acinetobacter baumannii infections in a medical intensive care unit.
- To identify the source and contributing factors of the outbreak.
- To determine effective treatment strategies and control measures for Acinetobacter infections.
Main Methods:
- Retrospective analysis of 16 cases of Acinetobacter baumannii infections over a 7-month period.
- Environmental and equipment cultures to identify potential sources.
- Antimicrobial susceptibility testing of Acinetobacter isolates.
- Comparison of infection rates between ventilated and non-ventilated patients.
Main Results:
- Fifteen of 16 patients developed ventilator-associated pneumonia.
- Patients on ventilators were significantly more susceptible to Acinetobacter infection (p < 0.05).
- Sputum cultures showed 100% sensitivity to imipenem, compared to 5% for ciprofloxacin and gentamicin (p < 0.0001).
- Implementation of imipenem therapy and control measures reduced Acinetobacter isolates from 77 to 9 in the subsequent year.
Conclusions:
- Imipenem was highly effective against the outbreak strain of Acinetobacter baumannii.
- Prompt identification and implementation of effective antimicrobial therapy (imipenem) were crucial in controlling the outbreak.
- Enhanced infection control measures, including appropriate antibiotic use, are vital in preventing and managing nosocomial Acinetobacter infections.