title: Molecular and epidemiologic study of polyclonal outbreaks of multidrug-resistant Acinetobacter baumannii infection in an Israeli hospital.
abstract: OBJECTIVE
  To perform a molecular and epidemiologic investigation of multidrug-resistant (MDR) Acinetobacter baumannii in an institution were polyclonal outbreaks have been observed and determine whether these polyclonal outbreaks had an endogenous origin or were caused by in-hospital patient-to-patient transmission.
  
  
  METHODS
  Retrospective analysis of prospectively collected data.
  
  
  METHODS
  An epidemiologic and genotypic investigation of incident cases of MDR A. baumannii infection in an Israeli university tertiary care center.
  
  
  METHODS
  Hospitalized patients with MDR A. baumannii isolated from clinical samples during a 13-week period, from April 15, 2003, through July 15, 2003.
  
  
  METHODS
  All patients with new MDR A. baumannii infections were recruited, and isolates were typed using pulsed-field gel electrophoresis. Data on in-hospital movements and consultations were extracted from computerized databases. Quantification of transmission opportunities (TOPs), defined as encounters between an established carrier and a future carrier of MDR A. baumannii, and analysis of ward clusters were performed.
  
  
  RESULTS
  We studied 96 MDR A. baumannii isolates, which belonged to 18 different pulsed-field gel electrophoresis clones. In 65% of cases, TOPs involving patients with the same clone were demonstrated, which is significantly greater than the number of TOPs involving patients with different clones (P=.01).
  
  
  CONCLUSIONS
  Although outbreaks of MDR A. baumannii infection may be polyclonal, we believe that patient-to-patient transmission explains most cases of transmission. Polyclonal local outbreaks reflect several clonal outbreaks occurring simultaneously. The cause of polyclonal outbreaks of A. baumannii infections clustered by ward and time remains to be explained.
authors.affiliation: Division of Epidemiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, 64239, Israel. drormc@netvision.net.il
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
authors.forename: Shiri
authors.initials: S
authors.lastname: Navon-Venezia
authors.forename: Azita
authors.initials: A
authors.lastname: Leavitt
authors.forename: Inna
authors.initials: I
authors.lastname: Chmelnitsky
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Schwaber
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000635:transmission*; D040981:Acinetobacter baumannii / Q000145:classification* / Q000472:pathogenicity; D000328:Adult; D003428:Cross Infection / Q000453:epidemiology / Q000635:transmission*; D018562:Disease Transmission, Infectious; D024901:Drug Resistance, Multiple, Bacterial; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel / Q000453:epidemiology; D017720:Molecular Epidemiology; D012189:Retrospective Studies