title: Multidrug-resistant Acinetobacter baumannii infection, colonization, and transmission related to a long-term care facility providing subacute care.
abstract: OBJECTIVE
  To investigate Acinetobacter baumannii infection, colonization, and transmission related to a long-term care facility (LTCF) providing subacute care (facility A).
  
  
  METHODS
  We reviewed facility A and affiliated local hospital records for facility A residents with A. baumannii isolated during the period January 2009 through February 2010 and compared A. baumannii antimicrobial resistance patterns of residents with those of hospital patients. During March 2010, we implemented a colonization survey of facility A residents who received respiratory support or who could provide sputum samples and looked for A. baumannii colonization risks. Available clinical and survey isolates underwent pulsed-field gel electrophoresis (PFGE); PFGE strains were linked with overlapping stays to identify possible transmission.
  
  
  RESULTS
  During the period January 2009 through February 2010, 33 facility A residents had A. baumannii isolates; all strains were multidrug resistant (MDR), which was a significantly higher prevalence of MDR strains than that found among isolates from hospital patients (81 [66%] of 122 hospital patient isolates were MDR; P < .001). The sputum survey found that 14 (20%) of 70 residents had A. baumannii colonization, which was associated with ventilator use (adjusted odds ratio, 4.24 [95% confidence interval, 1.06-16.93]); 12 (86%) of 14 isolates were MDR. Four facility A resident groups clustered with 3 PFGE strains and overlapping stays. One of these facility A residents also clustered with 3 patients at an affiliated hospital.
  
  
  CONCLUSIONS
  We documented substantial MDR A. baumannii infections and colonization with probable intra- and interfacility spread associated with a single LTCF providing subacute care. Given the limited infection prevention and antimicrobial stewardship resources in such settings, regional collaborations among facilities across the spectrum of health care are needed to address this MDR threat.
authors.affiliation: Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California.
authors.forename: Eva
authors.initials: E
authors.lastname: Mortensen
authors.forename: Kavita K
authors.initials: KK
authors.lastname: Trivedi
authors.forename: Jon
authors.initials: J
authors.lastname: Rosenberg
authors.forename: Sara H
authors.initials: SH
authors.lastname: Cody
authors.forename: Janet
authors.initials: J
authors.lastname: Long
authors.forename: Bette J
authors.initials: BJ
authors.lastname: Jensen
authors.forename: Duc J
authors.initials: DJ
authors.lastname: Vugia
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000635:transmission*; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003428:Cross Infection; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D016017:Odds Ratio; D012866:Skilled Nursing Facilities / Q000458:organization & administration*