title: A multidrug-resistant Acinetobacter baumannii outbreak in intensive care unit: antimicrobial and organizational strategies.
abstract: OBJECTIVE
  Multidrug-resistant Acinetobacter baumannii (MRAB) is an emerging cause of intensive care unit (ICU) outbreaks. Patients are the main reservoirs, inducing cross transmission. We describe an MRAB outbreak that occurred in the Prato Hospital ICU in June to August 2009.
  
  
  METHODS
  The ICU consists of 2 separated 4-bed rooms (rooms A and B). The MRAB-positive patients were included in our study. During the outbreak, infection control measures were enhanced; patients and environmental screenings were performed. A 6-month follow-up was carried out.
  
  
  RESULTS
  Four of 26 patients admitted during the outbreak were MRAB positive. All patients were located in room A; no case was detected in room B either in the hospital or during the follow-up. Management included closure to new admissions, reinforcement of infection control measures, patient and environmental screenings, discharge of room B MRAB-negative patients for at least 5 days after the first case identification. All isolates were carbapenems resistant and tigecycline and colistin susceptible. All patients received tigecycline: 2 were successfully treated, 1 died because of preexisting illness, and 1 developed resistance and recovered after colistin therapy.
  
  
  CONCLUSIONS
  Enhanced infection control measures and adequate antibiotic strategy limited the outbreak. Tigecycline allowed rapid recovery. Nevertheless, resistance ensued; so colistin remained the only therapeutic option. However, pan-drug resistance has been reported.
authors: Anaesthesia and Intensive Care Unit, Misericordia e Dolce Hospital, piazza dell'Ospedale 5, 59100 Prato, Italy. Electronic address: gconsales@gmail.com.
authors: Guglielmo
authors: G
authors: Consales
authors: Anaesthesia and Intensive Care Unit, Misericordia e Dolce Hospital, piazza dell'Ospedale 5, 59100 Prato, Italy.
authors: Elena
authors: E
authors: Gramigni
authors: Section of Anaesthesia and Intensive Care, Department of Critical Care, University of Florence, Viale Morgagni 85, 50134 Firenze, Italy.
authors: Lucia
authors: L
authors: Zamidei
authors: Anaesthesia and Intensive Care Unit, Misericordia e Dolce Hospital, piazza dell'Ospedale 5, 59100 Prato, Italy.
authors: Daniela
authors: D
authors: Bettocchi
authors: Section of Anaesthesia and Intensive Care, Department of Critical Care, University of Florence, Viale Morgagni 85, 50134 Firenze, Italy.
authors: Angelo Raffaele
authors: AR
authors: De Gaudio
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003091:Colistin / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units / Q000458:organization & administration*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000031:analogs & derivatives / Q000627:therapeutic use; D000078304:Tigecycline; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D000078304:Tigecycline; D008911:Minocycline; D003091:Colistin