Management and control of a carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit.
OBJECTIVE
We had for aim to describe the identification and management of a 14-clonal carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak, following admission of a known CRAB-infected patient in an ICU.


METHODS
We reviewed the carriers' files and outbreak management procedures.


RESULTS
The index patient was admitted with strict isolation precautions. The outbreak started 2 months after his discharge. It persisted despite reinforcement of strict isolation precautions, staff and patient cohorting, and extensive environmental decontamination including 2 rounds of routine terminal cleaning and disinfection or 1 round of cleaning and disinfection followed by hydrogen peroxide treatment. A second epidemic peak, after 4 weeks without any case, led to another wide environmental sampling and decontamination rounds. The source of the CRAB outbreak was suspected to be the blood pressure cuffs Velcro. Switching to cuffs submersible in a disinfectant stopped the outbreak.


CONCLUSIONS
CRAB outbreaks are difficult to manage and sources of persistent colonization can be unexpected.
Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France. Electronic address: alfandari.s@gmail.com.
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Alfandari
Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France.
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Gois
Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France.
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Delannoy
Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France.
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Georges
Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France.
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N
Boussekey
Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France.
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Chiche
Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France.
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Meybeck
Laboratoire de biologie, centre hospitalier de Tourcoing, 59208 Tourcoing, France.
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Patoz
Laboratoire de biologie, centre hospitalier de Tourcoing, 59208 Tourcoing, France.
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N
Blondiaux
Service universitaire des maladies infectieuses et du voyageur, centre hospitalier de Tourcoing, 59208 Tourcoing, France.
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Senneville
Service universitaire des maladies infectieuses et du voyageur, centre hospitalier de Tourcoing, 59208 Tourcoing, France.
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Melliez
Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France.
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Leroy
D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000328:Adult; D001003:Anal Canal / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015780:Carbapenems / Q000494:pharmacology* / Q000627:therapeutic use; D002353:Carrier State / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D003666:Decontamination / Q000379:methods*; D004196:Disease Outbreaks; D004202:Disinfectants; D004203:Disinfection; D004352:Drug Resistance, Microbial; D004866:Equipment Contamination; D004865:Equipment and Supplies, Hospital; D005602:France / Q000453:epidemiology; D006769:Hospitals, General; D006801:Humans; D006861:Hydrogen Peroxide; D007362:Intensive Care Units; D008297:Male; D010356:Patient Isolation; D010362:Patients' Rooms; D010564:Personnel, Hospital; D010614:Pharynx / Q000382:microbiology; D019722:Sphygmomanometers / Q000382:microbiology*; D016635:Universal Precautions
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D004202:Disinfectants; D006861:Hydrogen Peroxide
Acinetobacter baumannii; Multidrug resistance; Multirésistance; Outbreak; Épidémie