title: Repeated colonization by multi-drug-resistant Acinetobacter calcoaceticus-A. baumannii complex and changes in antimicrobial susceptibilities in surgical intensive care units.
abstract: BACKGROUND
  A nosocomial outbreak of multi-drug-resistant Acinetobacter calcoaceticus-A. baumannii (MDR-ACB) complex infection occurred in a newly constructed building at a 2,500-bed tertiary medical center in Taiwan.
  
  
  METHODS
  An investigation was carried out by molecular approaches to trace the bacteria. Antimicrobial susceptibilities, risk factors, and the occurrence of nosocomial MDR-ACB infections were investigated. From January to December 2009, 53 patients were infected with MDR-ACB, and 23 environmental surveys were performed in two surgical intensive care units (ICUs) within the new building. Forty-two clinical isolates were obtained from patients and 22 samples from nine environmental surveys.
  
  
  RESULTS
  Forty clinical isolates (95.2%) and 18 environmental samples (81.8%) were positive for MDR-ACB of type A, the predominant outbreak strain. This strain was identical to that isolated in an outbreak in the old hospital in 2006, as proved by repetitive extragenic palindromic-based polymerase chain reaction and pulsed-field gel electrophoresis. Although the outbreak isolates contained blaOXA-23-like and blaOXA-51-like genes, analysis of the antimicrobial susceptibilities demonstrated increases in resistance to cefepime and imipenem-cilastatin in MDR-ACB isolated in the later outbreak.
  
  
  CONCLUSIONS
  Not only patients or healthcare workers, but also medical equipment, might have carried the predominant outbreak strain from the old district to the new building. Therefore, even in a new environment, infection control programs must be enforced continually, and healthcare providers must be educated repeatedly to prevent recurrent outbreaks of MDR-ACB infection in the hospital setting.
authors: Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taichung, Taiwan.
authors: Cheng-Mao
authors: CM
authors: Ho
authors: Mao-Wang
authors: MW
authors: Ho
authors: Chih-Yu
authors: CY
authors: Chi
authors: Chia-Der
authors: CD
authors: Lin
authors: Cheng-Wen
authors: CW
authors: Lin
authors: Sung-Pin
authors: SP
authors: Tseng
authors: Lee-Jene
authors: LJ
authors: Teng
authors: Hsiao-Yun
authors: HY
authors: Chang
authors: Hui-Lan
authors: HL
authors: Chang
authors: Ya-Fen
authors: YF
authors: Chang
authors: Hsiu-Hsien
authors: HH
authors: Lin
authors: Ni
authors: N
authors: Tien
authors: Jang-Jih
authors: JJ
authors: Lu
authors: Chih-Ho
authors: CH
authors: Lai
mesh_terms: D000150:Acinetobacter / Q000187:drug effects* / Q000235:genetics / Q000254:growth & development* / Q000302:isolation & purification; D000151:Acinetobacter Infections / Q000382:microbiology*; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D000077723:Cefepime; D002511:Cephalosporins / Q000494:pharmacology; D016009:Chi-Square Distribution; D002681:China; D015377:Cilastatin / Q000494:pharmacology; D000077728:Cilastatin, Imipenem Drug Combination; D003422:Critical Care; D003428:Cross Infection / Q000382:microbiology*; D004196:Disease Outbreaks; D004338:Drug Combinations; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D062486:Public Health Surveillance; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D004338:Drug Combinations; D015377:Cilastatin; D015378:Imipenem; D000077723:Cefepime; D000077728:Cilastatin, Imipenem Drug Combination