title: Emergence of resistant Acinetobacter baumannii in critically ill patients within an acute care teaching hospital and a long-term acute care hospital.
abstract: BACKGROUND
  Acinetobacter baumannii is a gram-negative, coccobacillus found in water and is a significant nosocomial pathogen in hospitals. This report chronicles the appearance in June 2003 of a multidrug-resistant A baumannii (MDR-AB) strain, its dissemination, and interventions used to control it in an acute care hospital (ACH) and long-term acute care facility (LTAC).
  
  
  METHODS
  Molecular typing using pulsed-field gel electrophoresis (PFGE) showed that 88 of 99 strains (89%) gave an identical banding designated as clone A. Eight additional isolates were variants of clone A, and 3 isolates were unrelated.
  
  
  RESULTS
  A baumannii was isolated from 229 patients between January 2003 and December 2004. Of these patients, 151 (66%) were colonized/infected with MDR-AB. Most isolates were resistant to antibiotics except for imipenem and ampicillin/sulbactam. Isolates included 108 (72%) in the respiratory tract, 32 (21%) in wounds, 6 (4%) in blood, and 5 (3%) in urine. Most isolates were found in the LTAC (70 isolates), ICU step-down (27 isolates), and ICU (26 isolates).
  
  
  CONCLUSIONS
  This epidemiologic history illustrates (1) epidemic clonal spread, (2) target populations, (3) variable monthly prevalence, and (4) intervention outcomes. With intervention, the number of new isolates in the ACH decreased by dedicating an infection control professional to critical care, daily surveillance, isolation of positive MDR-AB patients, universal gloving, and routinely reporting results.
authors.affiliation: Summa Health System, Akron, OH 44309-2090, USA.
authors.forename: Claudester
authors.initials: C
authors.lastname: Stephens
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Francis
authors.forename: Virginia
authors.initials: V
authors.lastname: Abell
authors.forename: Joseph R
authors.initials: JR
authors.lastname: DiPersio
authors.forename: Patricia
authors.initials: P
authors.lastname: Wells
mesh_terms: D000151:Acinetobacter Infections / Q000145:classification / Q000188:drug therapy* / Q000453:epidemiology; D040981:Acinetobacter baumannii / Q000145:classification / Q000187:drug effects* / Q000472:pathogenicity; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006765:Hospitals, Convalescent; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D010356:Patient Isolation