Nosocomial outbreak of infection with pan-drug-resistant Acinetobacter baumannii in a tertiary care university hospital.
OBJECTIVE
To describe what is, to our knowledge, the first nosocomial outbreak of infection with pan-drug-resistant (including colistin-resistant) Acinetobacter baumannii, to determine the risk factors associated with these types of infections, and to determine their clinical impact.


METHODS
Nested case-control cohort study and a clinical-microbiological study.


METHODS
A 1,521-bed tertiary care university hospital in Seville, Spain.


METHODS
Case patients were inpatients who had a pan-drug-resistant A. baumannii isolate recovered from a clinical or surveillance sample obtained at least 48 hours after admission to an intensive care unit (ICU) during the time of the epidemic outbreak. Control patients were patients who were admitted to any of the "boxes" (ie, rooms that partition off a distinct area for a patient's bed and the equipment needed to care for the patient) of an ICU for at least 48 hours during the time of the epidemic outbreak.


RESULTS
All the clinical isolates had similar antibiotic susceptibility patterns (ie, they were resistant to all the antibiotics tested, including colistin), and, on the basis of repetitive extragenic palindromic-polymerase chain reaction, it was determined that all of them were of the same clone. The previous use of quinolones and glycopeptides and an ICU stay were associated with the acquisition of infection or colonization with pan-drug-resistant A. baumannii. To control this outbreak, we implemented the following multicomponent intervention program: the performance of environmental decontamination of the ICUs involved, an environmental survey, a revision of cleaning protocols, active surveillance for colonization with pan-drug-resistant A. baumannii, educational programs for the staff, and the display of posters that illustrate contact isolation measures and antimicrobial use recommendations.


CONCLUSIONS
We were not able to identify the common source for these cases of infection, but the adopted measures have proven to be effective at controlling the outbreak.
Valencia
Raquel
R
Preventive Medicine and Public Health Services, Virgen del Rocío Hospital, Avenida Manuel Siurot s/n, Seville 41013, Spain. raquel.valencia.sspa@juntadeandalucia.es
Arroyo
Luis A
LA
Conde
Manuel
M
Aldana
Josefa M
JM
Torres
María-José
MJ
Fernández-Cuenca
Felipe
F
Garnacho-Montero
José
J
Cisneros
José M
JM
Ortíz
Carlos
C
Pachón
Jerónimo
J
Aznar
Javier
J
D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002173:Cancer Care Facilities; D016022:Case-Control Studies; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
D000900:Anti-Bacterial Agents