title: Outbreak of multiresistant Acinetobacter baumannii in a polyvalent intensive care unit: clinical, epidemiological analysis and PFGE-printing evolution.
abstract: An outbreak of multidrug-resistant Acinetobacter baumannii (MRAB) occurred over the course of a 27-week period in our adult polyvalent intensive care unit (ICU). Twenty-one patients were affected, and 72 strains were identified from different clinical samples. The strains were resistant to all antibiotics except for colistin and ampicillin/sulbactam. Forty-nine MRAB strains collected from 18 patients were analysed by pulsed-field gel electrophoresis (PFGE). This analysis revealed four highly-related PFGE types (genetic similarity index >90%) termed 1, 2, 3 and 4, that were isolated in 13, seven, one, and three patients, respectively. A single PFGE type was identified from five of ten patients with successive isolation of MRAB; in the other five patients, two or three PFGE types were detected. This suggested phased evolution of PFGE types 2, 3 and 4 from PFGE type 1. Global mortality was high (13 patients; 62%). Non-survivors had higher APACHE II scores than survivors on the date that MRAB was isolated (OR = 1.57; 95% CI [1.02, 2.44]). The outbreak was controlled after implementation of an extensive infection control program.
authors.affiliation: Intensive Care Unit, Hospital Don Benito-Villanueva, Health Service of Extremadura, 06400, Don Benito, Badajoz, Spain. suso1@orangecorreo.es
authors.forename: J
authors.initials: J
authors.lastname: Monterrubio-Villar
authors.forename: C
authors.initials: C
authors.lastname: González-Velasco
authors.forename: S
authors.initials: S
authors.lastname: Valdezate-Ramos
authors.forename: A
authors.initials: A
authors.lastname: Córdoba-López
authors.forename: P
authors.initials: P
authors.lastname: Villalón-Panzano
authors.forename: J A
authors.initials: JA
authors.lastname: Saéz-Nieto
mesh_terms: D018806:APACHE; D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000235:genetics; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016000:Cluster Analysis; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D005838:Genotype; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008826:Microbial Sensitivity Tests; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents