title: Investigation and management of an imipenem-resistant oxa-23 Acinetobacter baumannii outbreak in an intensive care unit.
abstract: OBJECTIVE
  The study objectives were to describe the investigation and management of an imipenem-resistant Acinetobacter baumannii outbreak that occurred in the 15-bed ICU of a tertiary care teaching hospital (Brest, France), during the summer 2008.
  
  
  METHODS
  Patients harboring an imipenem-resistant A. baumannii strain were defined as case patients. We described case occurrence and steps taken to control the outbreak: contact isolation, reinforcement of hygiene procedures, unit shutdown decision, unit disinfection, and reopening. We also made a case control study and a cost analysis of the outbreak management.
  
  
  RESULTS
  During a 10-day period, five patients were positive for a single clone of imipenem-resistant oxa-23 A. baumannii. Four patients presented with ventilation-acquired pneumonia and one was asymptomatic. The first two patients died one day after the first swab which led to the identification of A. baumannii. No additional case was noted in the ICU or in other hospital units after deciding to close the ICU. The cost of outbreak management was estimated at 264,553 euros. The case control study identified several factors associated with infection or colonization: length of stay in the ICU, chronic respiratory disease, number of previous antibiotic classes used, duration of ventilation, prone position, echocardiography, and presence of a nasogastric tube.
  
  
  CONCLUSIONS
  This outbreak occurred during the summer period requiring the shutdown of the ICU and inducing a considerable cost. Rapid reactions of the ICU staff during the outbreak enabled to limit the epidemic.
authors.affiliation: Service santé publique, hygiène hospitalière, évaluation hôpital Morvan, avenue Foch, CHU de Brest, 29200 Brest, France. ronan.garlantezec@chu-brest.fr
authors.forename: R
authors.initials: R
authors.lastname: Garlantézec
authors.forename: C
authors.initials: C
authors.lastname: Bourigault
authors.forename: J-M
authors.initials: JM
authors.lastname: Boles
authors.forename: G
authors.initials: G
authors.lastname: Prat
authors.forename: R
authors.initials: R
authors.lastname: Baron
authors.forename: J-M
authors.initials: JM
authors.lastname: Tonnelier
authors.forename: M
authors.initials: M
authors.lastname: Cosse
authors.forename: M
authors.initials: M
authors.lastname: Lefevre
authors.forename: S
authors.initials: S
authors.lastname: Jourdain
authors.forename: G
authors.initials: G
authors.lastname: Lelay
authors.forename: L
authors.initials: L
authors.lastname: Daniel
authors.forename: M
authors.initials: M
authors.lastname: Virmaux
authors.forename: I
authors.initials: I
authors.lastname: Le Du
authors.forename: D
authors.initials: D
authors.lastname: Tande
authors.forename: A
authors.initials: A
authors.lastname: Renault
authors.forename: B
authors.initials: B
authors.lastname: Lejeune
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology*; D040981:Acinetobacter baumannii / Q000187:drug effects*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology*; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D015378:Imipenem / Q000494:pharmacology*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem