title: Nosocomial outbreak of carbapenem-resistant Acinetobacter baumannii in intensive care units and successful outbreak control program.
abstract: Acinetobacter baumannii has been increasingly reported as a significant causative organism of various nosocomial infections. Here we describe an outbreak of carbapenem-resistant A. baumannii (CRAB) in the ICUs of a Korean university hospital, along with a successful outbreak control program. From October 2007 through July 2008, CRAB was isolated from 57 ICU patients. Nineteen patients were diagnosed as being truly infected with CRAB, four of whom were presumed to have died due to CRAB infection, producing a case-fatality rate of 21.1%. In surveillance of the environment and the healthcare workers (HCWs), CRAB was isolated from 24 (17.9%) of 135 environmental samples and seven (10.9%) of 65 HCWs. The pulsed field gel electrophoresis patterns showed that the isolates from patients, HCWs, and the environment were genetically related. Control of the outbreak was achieved by enforcing contact precautions, reducing environmental contamination through massive cleaning, and use of a closed-suctioning system. By August 2008 there were no new cases of CRAB in the ICUs. This study shows that the extensive spread of CRAB can happen through HCWs and the environmental contamination, and that proper strategies including strict contact precautions, massive environmental decontamination, and a closed-suctioning system can be effective for controlling CRAB outbreaks.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Won Suk
authors.initials: WS
authors.lastname: Choi
authors.forename: Su Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Eun Gyong
authors.initials: EG
authors.lastname: Jeon
authors.forename: Myeung Hee
authors.initials: MH
authors.lastname: Son
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Yoon
authors.forename: Jung-Yeon
authors.initials: JY
authors.lastname: Kim
authors.forename: Mi Jeong
authors.initials: MJ
authors.lastname: Kim
authors.forename: Jang Wook
authors.initials: JW
authors.lastname: Sohn
authors.forename: Min Ja
authors.initials: MJ
authors.lastname: Kim
authors.forename: Dae Won
authors.initials: DW
authors.lastname: Park
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D040981:Acinetobacter baumannii / Q000302:isolation & purification / Q000378:metabolism / Q000472:pathogenicity*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents