title: Occupational transmission of Acinetobacter baumannii from a United States serviceman wounded in Iraq to a health care worker.
abstract: BACKGROUND
  Acinetobacter baumannii is increasingly recognized as being a significant pathogen associated with nosocomial outbreaks in both civilian and military treatment facilities. Current analyses of these outbreaks frequently describe patient-to-patient transmission. To date, occupational transmission of A. baumannii from a patient to a health care worker (HCW) has not been reported. We initiated an investigation of an HCW with a complicated case of A. baumannii pneumonia to determine whether a link existed between her illness and A. baumannii-infected patients in a military treatment facility who had been entrusted to her care.
  
  
  METHODS
  Pulsed-field gel electrophoresis and polymerase chain reaction/electrospray ionization mass spectrometry, a form of multilocus sequencing typing, were done to determine clonality. To further characterize the isolates, we performed a genetic analysis of resistance determinants.
  
  
  CONCLUSIONS
  A "look-back" analysis revealed that the multidrug resistant A. baumannii recovered from the HCW and from a patient in her care were indistinguishable by pulsed-field gel electrophoresis. In addition, polymerase chain reaction/electrospray ionization mass spectrometry indicated that the isolates were similar to strains of A. baumannii derived from European clone type II (Walter Reed Army Medical Center strain type 11). The exposure of the HCW to the index patient lasted for only 30 min and involved endotracheal suctioning without use of an HCW mask. An examination of 90 A. baumannii isolates collected during this investigation showed that 2 major and multiple minor clone types were present and that the isolates from the HCW and from the index patient were the most prevalent clone type. Occupational transmission likely occurred in the hospital; HCWs caring for patients infected with A. baumannii should be aware of this potential mode of infection spread.
authors.affiliation: Infectious Diseases Division, Department of Medicine, National Naval Medical Center, Bethesda, Maryland, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Whitman
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Qasba
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Timpone
authors.forename: Britta S
authors.initials: BS
authors.lastname: Babel
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Kasper
authors.forename: Judith F
authors.initials: JF
authors.lastname: English
authors.forename: John W
authors.initials: JW
authors.lastname: Sanders
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Hujer
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Hujer
authors.forename: Andrea
authors.initials: A
authors.lastname: Endimiani
authors.forename: Mark W
authors.initials: MW
authors.lastname: Eshoo
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bonomo
mesh_terms: D000151:Acinetobacter Infections / Q000382:microbiology / Q000635:transmission*; D040981:Acinetobacter baumannii / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006282:Health Personnel; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D007493:Iraq; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D016273:Occupational Exposure; D018410:Pneumonia, Bacterial / Q000382:microbiology / Q000635:transmission*; D016133:Polymerase Chain Reaction; D021241:Spectrometry, Mass, Electrospray Ionization; D014481:United States; D014857:Warfare
chemical_list: D000900:Anti-Bacterial Agents