title: Control of carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit of a teaching hospital in Southern Italy.
abstract: BACKGROUND
  Acinetobacter baumannii is an opportunistic pathogen that has become a major cause of concern, since it is a frequent cause of healthcare-associated infections (HAIs). The aim of the study was to describe the occurrence, the management and the control of an outbreak that occurred in an intensive care unit (ICU) of a teaching hospital in Southern Italy caused by multiple strains of extensively drug-resistant A. baumannii (XDRAB).
  
  
  METHODS
  Case-patient was defined as a patient with an healthcare-associated infection caused by an XDRAB isolate identified in a clinically significant culture. Environmental samples were collected from different surfaces. The isolates were identified by typical Gram stain morphology, using the Vitek 2 system (bioMérieux, France) and by MALDI-TOF MS mass spectrometry (bioMèrieux, France). Genotyping was performed through rep-PCR analysis.
  
  
  RESULTS
  A patient presented an XDRAB ventilator-associated pneumonia at admission and was managed with strict isolation precautions until discharge. Five patients had a ventilator-associated pneumonia and two had a central line-associated bloodstream infection. Of the environmental samples, 1 sample obtained from the side of the bed of an infected patient yielded growth of XDRAB. Infection control measures were adopted. Rep-PCR analysis identified four patterns.
  
  
  CONCLUSIONS
  The integration of epidemiological and microbiological data and the application of infection control measures were crucial to bring such an outbreak to a rapid halt. The distinctive characteristic of this study was the complex molecular pattern of the outbreak, which subsided in a short period of time due to adherence to infection-control measures, confirming the fundamental role of molecular typing in the comprehension of outbreaks dynamics and of integrated control interventions for the interruption of epidemic events.
authors.affiliation: Department of Health Sciences, University of Catanzaro "Magna Græcia", 88100, Catanzaro, Italy.
authors.forename: Aida
authors.initials: A
authors.lastname: Bianco
authors.affiliation: Department of Health Sciences, University of Catanzaro "Magna Græcia", 88100, Catanzaro, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Quirino
authors.affiliation: Department of Health Sciences, University of Catanzaro "Magna Græcia", 88100, Catanzaro, Italy.
authors.forename: Mariavalentina
authors.initials: M
authors.lastname: Giordano
authors.affiliation: Department of Health Sciences, University of Catanzaro "Magna Græcia", 88100, Catanzaro, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Marano
authors.affiliation: Department of Health Sciences, University of Catanzaro "Magna Græcia", 88100, Catanzaro, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Rizzo
authors.affiliation: Department of Health Sciences, University of Catanzaro "Magna Græcia", 88100, Catanzaro, Italy.
authors.forename: Maria Carla
authors.initials: MC
authors.lastname: Liberto
authors.affiliation: Department of Health Sciences, University of Catanzaro "Magna Græcia", 88100, Catanzaro, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Focà
authors.affiliation: Department of Health Sciences, University of Catanzaro "Magna Græcia", 88100, Catanzaro, Italy. pavia@unicz.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Pavia
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000235:genetics* / Q000302:isolation & purification / Q000378:metabolism; D000328:Adult; D000368:Aged; D015780:Carbapenems / Q000494:pharmacology; D004269:DNA, Bacterial / Q000302:isolation & purification / Q000378:metabolism; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D005260:Female; D005838:Genotype; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
chemical_list: D015780:Carbapenems; D004269:DNA, Bacterial
keywords: Acinetobacter baumannii; Extensively drug resistance; Infection control; Intensive care unit; Outbreak; Rep-PCR