title: A gloves-associated outbreak of imipenem-resistant Acinetobacter baumannii in an intensive care unit in Guangdong, China.
abstract: BACKGROUND
  Imipenem-resistant Acinetobacter baumannii (IRAB) is an important cause of hospital-acquired infection. We aimed to describe an outbreak of IRAB infection and to investigate its possible source in an intensive care unit.
  
  
  METHODS
  An environmental investigation was undertaken. Antimicrobial susceptibility testing was performed by microdilution. These isolates were genotyped by use of repetitive extragenic palindromic polymerase chain reaction (rep-PCR; DiversiLab). The study included 11 patients infected with IRAB and 14 control patients free of IRAB. Case and control patients were compared for possible predisposing factors. A multifaceted intervention was implemented to control the outbreak.
  
  
  RESULTS
  Thirty-nine IRABs were isolated from patients and the environmental surveillance culture in August, November, and December 2011. All isolates were resistant to imipenem. The IRAB strains belonged to seven clones (A-G) by the use of rep-PCR. There were four epidemic clones (D-G) in the outbreak, and Clone D was predominant. For the case-control study, patients with chronic obstructive pulmonary disease were susceptible to infection with IRAB. The hospital mortality of the case group was significantly higher than that of the control group.
  
  
  CONCLUSIONS
  The outbreak strains were transmitted among infected patients and equipment by inappropriate use of gloves. A combination of aggressive infection control measures is essential for preventing recurrent nosocomial outbreaks of IRAB.
authors.affiliation: Department of Infection Control, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. doctordan@126.com.
authors.forename: Dan
authors.initials: D
authors.lastname: Ye
authors.affiliation: Department of Infection Control, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. isabels@126.com.
authors.forename: Jinglan
authors.initials: J
authors.lastname: Shan
authors.affiliation: State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. yongbo2046@163.com.|Intensive Care Unit, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. yongbo2046@163.com.
authors.forename: Yongbo
authors.initials: Y
authors.lastname: Huang
authors.affiliation: State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. ljc1648@163.com.|Intensive Care Unit, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. ljc1648@163.com.
authors.forename: Jianchun
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Infection Control, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. gygrglb@126.com.
authors.forename: Changan
authors.initials: C
authors.lastname: Li
authors.affiliation: State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. lxq1118@126.com.|Intensive Care Unit, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. lxq1118@126.com.
authors.forename: Xiaoqing
authors.initials: X
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. heweiqun@126.com.|Intensive Care Unit, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. heweiqun@126.com.
authors.forename: Weiqun
authors.initials: W
authors.lastname: He
authors.affiliation: State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. dryiminli@vip.163.com.|Intensive Care Unit, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. dryiminli@vip.163.com.
authors.forename: Yimin
authors.initials: Y
authors.lastname: Li
authors.affiliation: State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. maopu1981@126.com.
authors.forename: Pu
authors.initials: P
authors.lastname: Mao
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D004196:Disease Outbreaks / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial; D004866:Equipment Contamination; D005260:Female; D017575:Gloves, Protective / Q000382:microbiology; D006801:Humans; D015378:Imipenem / Q000494:pharmacology*; D017053:Infection Control; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem