title: Successful control of an outbreak of GES-5 extended-spectrum β-lactamase-producing Pseudomonas aeruginosa in a long-term care facility in Japan.
abstract: BACKGROUND
  Little is known about multidrug-resistant Pseudomonas aeruginosa (MDRP) outbreaks in long-term care facilities (LTCFs).
  
  
  OBJECTIVE
  To describe an MDRP outbreak in an LTCF and to clarify risk factors for MDRP acquisition.
  
  
  METHODS
  Patients who were positive for MDRP at an LTCF from January 2013 to January 2014 were analysed. A descriptive analysis, a case-control study, and a microbiological analysis were performed.
  
  
  RESULTS
  A total of 23 MDRP cases were identified, 16 of which were confirmed in sputum samples. Healthcare workers were observed violating hand hygiene procedures when performing oral, wound, and genital care. Nasogastric tube and oxygen mask use was associated with MDRP acquisition in the respiratory tract, which might have been confounded by poor hand hygiene. Sharing unhygienic devices, such as portable oral suction devices for oral care, and washing bottles and ointments for wound and genital care with inadequate disinfection could explain the transmission of MDRP in some cases. Isolates from 11 patients were found to be indistinguishable or closely related by pulsed-field gel electrophoresis and harbouring the blaGES-5 gene. Subsequent enhanced infection control measures were supported by nearby hospitals and a local public health centre. No additional cases were identified for a year after the last case occurred in January 2014.
  
  
  CONCLUSIONS
  An outbreak of MDRP with an antimicrobial resistance gene, blaGES-5, occurred in a Japanese LTCF. It was successfully controlled by enhanced infection control measures, which neighbouring hospitals and a local public health centre supported.
authors.affiliation: Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan; Department of Global Infectious Diseases and Tropical Medicine, National Defense Medical College, Saitama, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Kanayama
authors.affiliation: Division of Bacteriology, Osaka Prefectural Institute of Public Health, Osaka, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Kawahara
authors.affiliation: Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan. Electronic address: tack-8@nih.go.jp.
authors.forename: T
authors.initials: T
authors.lastname: Yamagishi
authors.affiliation: Shinsei Hospital, Osaka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Goto
authors.affiliation: Shinsei Hospital, Osaka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kobaru
authors.affiliation: Takatsuki City Health Center, Osaka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Takano
authors.affiliation: Takatsuki City Health Center, Osaka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Morisada
authors.affiliation: Infection Control Center, Osaka Medical College Hospital, Osaka, Japan; Department of General Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Ukimura
authors.affiliation: Infection Control Center, Osaka Medical College Hospital, Osaka, Japan.
authors.forename: F
authors.initials: F
authors.lastname: Kawanishi
authors.affiliation: Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Tabuchi
authors.affiliation: Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Matsui
authors.affiliation: Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Oishi
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006268:Health Facilities; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007564:Japan / Q000453:epidemiology; D008134:Long-Term Care; D008297:Male; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000517:prevention & control; D011550:Pseudomonas aeruginosa / Q000201:enzymology* / Q000302:isolation & purification; D012307:Risk Factors; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases
keywords: GES-5; Long-term care facility; Multidrug-resistant Pseudomonas aeruginosa; Oral care