Control of an outbreak of pandrug-resistant Acinetobacter baumannii colonization and infection in a neonatal intensive care unit.
OBJECTIVE
To investigate the potential reservoir and mode of transmission of pandrug-resistant (PDR) Acinetobacter baumannii in a 7-day-old neonate who developed PDR A. baumannii bacteremia that was presumed to be the iceberg of a potential outbreak.


METHODS
Outbreak investigation based on a program of prospective hospital-wide surveillance for nosocomial infection.


METHODS
A 24-bed neonatal intensive care unit in a 2,200-bed major teaching hospital in Taiwan that provides care for critically ill neonates born in this hospital and those transferred from other hospitals.


METHODS
Samples from 33 healthcare workers' hands and 40 samples from the environment were cultured. Surveillance cultures of anal swab specimens and sputum samples were performed for neonates on admission to the neonatal intensive care unit and every 2 weeks until discharge. The PDR A. baumannii isolates, defined as isolates resistant to all currently available systemic antimicrobials except polymyxin B, were analyzed by pulsed-field gel electrophoresis. Control measures consisted of implementing contact isolation, reinforcing hand hygiene adherence, cohorting of nurses, and environmental cleaning.


RESULTS
One culture of an environmental sample and no cultures of samples from healthcare workers' hands grew PDR A. baumannii. The positive culture result involved a sample obtained from a ventilation tube used by the index patient. During the following 2 months, active surveillance identified PDR A. baumannii in 8 additional neonates, and isolates from 7 had the same electrokaryotype. Of the 9 neonates colonized or infected with PDR A. baumannii, 1 died from an unrelated condition. Reinforcement of infection control measures resulted in 100% adherence to proper hand hygiene protocol. The outbreak was stopped without compromising patient care.


CONCLUSIONS
In the absence of environmental contamination, transient hand carriage by personnel who cared for neonates colonized or infected with PDR A. baumannii was suspected to be the mode of transmission. Vigilance, prompt intervention and strict adherence to hand hygiene protocol were the key factors that led to the successful control of this outbreak. Active surveillance appears to be an effective measure to identify potential transmitters and reservoirs of PDR A. baumannii.
Chan
Pei-Chun
PC
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Huang
Li-Min
LM
Lin
Hui-Chi
HC
Chang
Luan-Yin
LY
Chen
Mei-Ling
ML
Lu
Chun-Yi
CY
Lee
Ping-Ing
PI
Chen
Jung-Min
JM
Lee
Chin-Yun
CY
Pan
Hui-Jui
HJ
Wang
Jann-Tay
JT
Chang
Shan-Chwen
SC
Chen
Yee-Chun
YC
D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000453:epidemiology; D040981:Acinetobacter baumannii / Q000145:classification / Q000187:drug effects*; D002353:Carrier State; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000517:prevention & control*; D004197:Disease Reservoirs; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006235:Hand Disinfection; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D010356:Patient Isolation; D013624:Taiwan / Q000453:epidemiology