Carbapenemase-producing Acinetobacter baumannii: An outbreak report with special highlights on economic burden.
OBJECTIVE
We aimed to describe the management of a carbapenemase-producing Acinetobacter baumannii (CP-AB) outbreak using the Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) statement. We also aimed to evaluate the cost of the outbreak and simulate costs if a dedicated unit to manage such outbreak had been set-up.


METHODS
We performed a prospective epidemiological study. Multiple interventions were implemented including cohorting measures and limitation of admissions. Cost estimation was performed using administrative local data.


RESULTS
Five patients were colonized with CP-AB and hospitalized in the neurosurgery ward. The index case was a patient who had been previously hospitalized in Portugal. Four secondary colonized patients were further observed within the unit. The strains of A. baumannii were shown to belong to the same clone and all of them produced an OXA-23 carbapenemase. The closure of the ward associated with the discharge of the five patients in a cohorting area of the Infectious Diseases Unit with dedicated staff put a stop to the outbreak. The estimated cost of this 17-week outbreak was $474,474. If patients had been managed in a dedicated unit - including specific area for cohorting of patients and dedicated staff - at the beginning of the outbreak, the estimated cost would have been $189,046.


CONCLUSIONS
Controlling hospital outbreaks involving multidrug-resistant bacteria requires a rapid cohorting of patients. Using simulation, we highlighted cost gain when using a dedicated cohorting unit strategy for such an outbreak.
Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
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Gagnaire
Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
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Gagneux-Brunon
Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
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Pouvaret
Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
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Grattard
Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
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Carricajo
Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
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Favier
Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
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Mattei
Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
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Pozzetto
Neurosurgery unit, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
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Nuti
Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
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Lucht
Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France; Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France. Electronic address: philippe.berthelot@chu-st-etienne.fr.
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Berthelot
Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
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Botelho-Nevers
D000151:Acinetobacter Infections / Q000191:economics / Q000453:epidemiology / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000201:enzymology*; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000032:analysis*; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology / Q000382:microbiology*; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D005602:France / Q000453:epidemiology; D005102:Health Expenditures / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006748:Hospital Departments; D006757:Hospital Units / Q000191:economics; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D055552:Infectious Disease Medicine; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery; D010356:Patient Isolation / Q000191:economics; D011446:Prospective Studies; D062606:Tertiary Care Centers / Q000191:economics; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000032:analysis*
D001426:Bacterial Proteins; C466679:beta-lactamase OXA-23; D001618:beta-Lactamases; C063912:carbapenemase
Acinetobacter baumannii; Bactéries productrices de carbapénémases; Carbapenemase-producing bacteria; Cost analysis; Disease outbreak; Épidémie; Évaluation médico-économique