title: Bed rails and endotracheal tube connectors as possible sources for spreading Acinetobacter baumannii in ventilator-associated pneumonia patients.
abstract: This study aimed to determine molecular patterns of Acinetobacter baumannii using a PCR-based technique with REP-1, REP-2 and M13 primers to distinguish the patients' strains and the environmental strains (condensate, endotracheal tube connector, bed rail and nurses hands). There were 67 cases of ventilator-associated pneumonia (VAP) among 600 patients using mechanical ventilators in 10 wards from March to July 2006. The incidence of VAP was 11.2% or 8.9/1,000 ventilator days with a 54.5% fatality rate. Among 19 of 22 A. baumannii VAP patients, 68.4% (13/19) had their environmental samples contaminated with A. baumannii and the most common contaminated sites were bed rails and endotracheal tube connectors (36.8% each). Multidrug resistant (MDR) A. baumannii were involved in 77.3% of A. baumannii VAP. Molecular typing of 96 A. baumannii isolates was able to differentiate A. baumannii isolates into 7 types. Type 2 was the most common and found in 77.3% (17/22) of A. baumannii VAP patients admitted in 6 of 7 wards. Identical fingerprints were found in clinical isolates and their bed rails, endotracheal tube connectors and condensates of 5 patients. The results demonstrate that multiple clones of MDR A. baumannii were widely spread in the hospital. Bed rails and contaminated endotracheal tube connectors could be potential sources of A. baumannii spread.
authors.affiliation: Department of Microbiology, Faculty of Public Health, Mahidol University, 420/1 Ratchawithi Road, Bangkok 10400, Thailand.
authors.forename: Suphawita
authors.initials: S
authors.lastname: Chaladchalam
authors.forename: Pornphan
authors.initials: P
authors.lastname: Diraphat
authors.forename: Fuangfa
authors.initials: F
authors.lastname: Utrarachkij
authors.forename: Orasa
authors.initials: O
authors.lastname: Suthienkul
authors.forename: Rudiwilai
authors.initials: R
authors.lastname: Samakoses
authors.forename: Kanokrat
authors.initials: K
authors.lastname: Siripanichgon
mesh_terms: D000151:Acinetobacter Infections / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000235:genetics / Q000302:isolation & purification*; D000328:Adult; D001513:Beds / Q000382:microbiology*; D002648:Child; D003428:Cross Infection / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008826:Microbial Sensitivity Tests; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology*; D016133:Polymerase Chain Reaction; D011446:Prospective Studies