title: Outbreak of carbapenem-resistant Acinetobacter baumannii carrying the carbapenemase OXA-23 in a German university medical centre.
abstract: A prolonged outbreak of carbapenem-resistant Acinetobacter baumannii in a German university medical centre in 2006 was investigated; the investigation included a descriptive epidemiological analysis, a case-control study, environmental sampling, molecular typing of A. baumannii isolates using PFGE and repetitive-sequence-based PCR (rep-PCR) typing, and detection of OXA-type carbapenemases by multiplex PCR. Thirty-two patients acquired the outbreak strain in five intensive care units (ICUs) and two regular wards at a tertiary care hospital within 10 months. The outbreak strain was resistant to penicillins, cephalosporins, ciprofloxacin, gentamicin, tobramycin, imipenem and meropenem, and carried the bla(OXA-23)-like gene. Based on PFGE and rep-PCR typing, it was shown to be related to the pan-European A. baumannii clone II. The most likely mode of transmission was cross-transmission from colonized or infected patients via the hands of health-care workers, with the severity of disease and intensity of care (therapeutic intervention scoring system 28 score >median) being independently associated with acquisition of the outbreak strain (odds ratio 6.67, 95 % confidence interval 1.55-36.56). Control of the outbreak was achieved by enforcement of standard precautions, education of personnel, screening of ICU patients for carbapenem-resistant A. baumannii and cohorting of patients. This is believed to be the first report of an outbreak of A. baumannii carrying the carbapenemase OXA-23 in Germany.
authors: Institute of Hygiene and Environmental Medicine, Charité University Medicine, Hindenburgdamm 27, 12203 Berlin, Germany.
authors: Anke
authors: A
authors: Kohlenberg
authors: Institute of Hygiene and Environmental Medicine, Charité University Medicine, Hindenburgdamm 27, 12203 Berlin, Germany.
authors: Sophie
authors: S
authors: Brümmer
authors: Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.
authors: Paul G
authors: PG
authors: Higgins
authors: Institute of Hygiene and Environmental Medicine, Charité University Medicine, Hindenburgdamm 27, 12203 Berlin, Germany.
authors: Dorit
authors: D
authors: Sohr
authors: Institute of Hygiene and Environmental Medicine, Charité University Medicine, Hindenburgdamm 27, 12203 Berlin, Germany.
authors: Brar C
authors: BC
authors: Piening
authors: Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany.
authors: Clemens
authors: C
authors: de Grahl
authors: Institute for Microbiology and Hygiene, Charité University Medicine, Berlin, Germany.
authors: Elke
authors: E
authors: Halle
authors: Institute of Hygiene and Environmental Medicine, Charité University Medicine, Hindenburgdamm 27, 12203 Berlin, Germany.
authors: Henning
authors: H
authors: Rüden
authors: Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.
authors: Harald
authors: H
authors: Seifert
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D040981:Acinetobacter baumannii / Q000145:classification / Q000187:drug effects* / Q000235:genetics; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D015780:Carbapenems / Q000494:pharmacology* / Q000627:therapeutic use; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D005858:Germany / Q000453:epidemiology; D006801:Humans; D017053:Infection Control / Q000379:methods; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; C466679:beta-lactamase OXA-23; D001618:beta-Lactamases