The Emergence of Resistant Strains of Acinetobacter baumannii: Clinical and Infection Control Implications

1999 ◽  
Vol 20 (8) ◽  
pp. 565-567 ◽  
Author(s):  
Marie Eve Dy ◽  
Jill A. Nord ◽  
Vincent J. LaBombardi ◽  
Jay W. Kislak
Keyword(s):  
Infection Control ◽  
Prospective Study ◽  
Acinetobacter Baumannii ◽  
Antibiotic Use ◽  
Control Measures ◽  
Infection Control Measures ◽  
Resistant Strains ◽  
A Prospective Study ◽  
Susceptibility Profiles ◽  
Colonization Rates

AbstractA prospective study was undertaken to determine colonization rates, susceptibility profiles, and outcomes in patients with clinical isolates of Acinetobacter baumannii. Fifty percent of patients became colonized with A baumannii, and 29% of these patients had clinical and colonizing isolates with discordant susceptibility profiles, without apparent relation to antibiotic use. Barrier infection control measures are necessary to prevent nosocomial transmission.

scholarly journals Why sensitive bacteria are resistant to hospital infection control

2017 ◽  
Vol 2 ◽  
pp. 16 ◽  
Author(s):  
Esther van Kleef ◽  
Nantasit Luangasanatip ◽  
Marc J Bonten ◽  
Ben S. Cooper
Keyword(s):  
Hand Hygiene ◽  
Infection Control ◽  
Resistant Strain ◽  
Mechanistic Model ◽  
Antibiotic Use ◽  
Sensitive Strain ◽  
Control Measures ◽  
Infection Control Measures ◽  
Hospital Infection Control ◽  
Resistant Strains

Background: Large reductions in the incidence of antibiotic-resistant strains of Staphylococcus aureus and Clostridium difficile have been observed in response to multifaceted hospital-based interventions. Reductions in antibiotic-sensitive strains have been smaller or non-existent. It has been argued that since infection control measures, such as hand hygiene, should affect resistant and sensitive strains equally, observed changes must have largely resulted from other factors, including changes in antibiotic use. We used a mathematical model to test the validity of this reasoning. Methods: We developed a mechanistic model of resistant and sensitive strains in a hospital and its catchment area. We assumed the resistant strain had a competitive advantage in the hospital and the sensitive strain an advantage in the community. We simulated a hospital hand hygiene intervention that directly affected resistant and sensitive strains equally. The annual incidence rate ratio (IRR) associated with the intervention was calculated for hospital- and community-acquired infections of both strains. Results: For the resistant strain, there were large reductions in hospital-acquired infections (0.1 ≤ IRR ≤ 0.6) and smaller reductions in community-acquired infections (0.2 ≤ IRR ≤  0.9). These reductions increased in line with increasing importance of nosocomial transmission of the strain. For the sensitive strain, reductions in hospital acquisitions were much smaller (0.6 ≤ IRR ≤ 0.9), while communityacquisitions could increase or decrease (0.9 ≤ IRR ≤ 1.2). The greater the importance of the community environment for the transmission of the sensitive strain, the smaller the reductions. Conclusions: Counter-intuitively, infection control interventions, including hand hygiene, can have strikingly discordant effects on resistant and sensitive strains even though they target them equally, following differences in their adaptation to hospital and community-based transmission. Observed lack of effectiveness of control measures for sensitive strains does not provide evidence that infection control interventions have been ineffective in reducing resistant strains.

scholarly journals Why sensitive bacteria are resistant to hospital infection control

2017 ◽  
Vol 2 ◽  
pp. 16 ◽  
Author(s):  
Esther van Kleef ◽  
Nantasit Luangasanatip ◽  
Marc J Bonten ◽  
Ben S. Cooper
Keyword(s):  
Hand Hygiene ◽  
Infection Control ◽  
Resistant Strain ◽  
Mechanistic Model ◽  
Antibiotic Use ◽  
Sensitive Strain ◽  
Control Measures ◽  
Infection Control Measures ◽  
Hospital Infection Control ◽  
Resistant Strains

Background: Large reductions in the incidence of antibiotic-resistant strains of Staphylococcus aureus and Clostridium difficile have been observed in response to multifaceted hospital-based interventions. Reductions in antibiotic-sensitive strains have been smaller or non-existent. It has been argued that since infection control measures, such as hand hygiene, should affect resistant and sensitive strains equally, observed changes must have largely resulted from other factors, including changes in antibiotic use. We used a mathematical model to test the validity of this reasoning. Methods: We developed a mechanistic model of resistant and sensitive strains in a hospital and its catchment area. We assumed the resistant strain had a competitive advantage in the hospital and the sensitive strain an advantage in the community. We simulated a hospital hand hygiene intervention that directly affected resistant and sensitive strains equally. The annual incidence rate ratio (IRR) associated with the intervention was calculated for hospital- and community-acquired infections of both strains. Results: For the resistant strain, there were large reductions in hospital-acquired infections (0.1 ≤ IRR ≤ 0.6) and smaller reductions in community-acquired infections (0.2 ≤ IRR ≤ 0.9). These reductions increased in line with increasing importance of nosocomial transmission of the strain. For the sensitive strain, reductions in hospital acquisitions were much smaller (0.6 ≤ IRR ≤ 0.9), while community acquisitions could increase or decrease (0.9 ≤ IRR ≤ 1.2). The greater the importance of the community environment for the transmission of the sensitive strain, the smaller the reductions. Conclusions: Counter-intuitively, infection control interventions, including hand hygiene, can have strikingly discordant effects on resistant and sensitive strains even though they target them equally. This follows from differences in their adaptation to hospital- and community-based transmission. Observed lack of effectiveness of control measures for sensitive strains does not provide evidence that infection control interventions have been ineffective in reducing resistant strains.

scholarly journals Intensified Infection Control Measures to Minimize the Spread of Colistin-Resistant Acinetobacter baumannii

2013 ◽  
Vol 34 (4) ◽  
pp. 445-447 ◽  
Author(s):  
Anucha Apisaranthanarak ◽  
Sassinuch Rujanavech ◽  
Pornpong Luxamesathaporn ◽  
Linda M. Mundy
Keyword(s):  
Infection Control ◽  
Acinetobacter Baumannii ◽  
Control Measures ◽  
Infection Control Measures

scholarly journals The Emergence ofClostridium difficileInfection among Peripartum Women: A Case-Control Study of aC. difficileOutbreak on an Obstetrical Service

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Jennifer A. Unger ◽  
Estella Whimbey ◽  
Michael G. Gravett ◽  
David A. Eschenbach
Keyword(s):  
Infection Control ◽  
Case Control Study ◽  
Clinical Manifestations ◽  
Antibiotic Use ◽  
Case Control ◽  
Control Measures ◽  
Multiple Infection ◽  
Infection Control Measures ◽  
Significant Independent Risk Factor ◽  
Control Study

Objective. An outbreak of 20 peripartumClostridium difficileinfections (CDI) occurred on the obstetrical service at the University of Washington Medical Center (UWMC) between April 2006 and June 2007. In this report, we characterize the clinical manifestations, describe interventions that appeared to reduce CDI, and determine potential risk factors for peripartum CDI.Methods. An investigation was initiated after the first three peripartum CDI cases. Based on the findings, enhanced infection control measures and a modified antibiotic regimen were implemented. We conducted a case-control study of peripartum cases and unmatched controls.Results. During the outbreak, there was an overall incidence of 7.5 CDI cases per 1000 deliveries. Peripartum CDI infection compared to controls was significantly associated with cesarean delivery (70% versus 34%;P=0.03), antibiotic use (95% versus 56%;P=0.001), chorioamnionitis (35% versus 5%;P=0.001), and the use of the combination of ampicillin, gentamicin, and clindamycin (50% versus 3%;P<0.001). Use of combination antibiotics remained a significant independent risk factor for CDI in the multivariate analysis.Conclusions. The outbreak was reduced after the implementation of multiple infection control measures and modification of antibiotic use. However, sporadic CDI continued for 8 months after these measures slowed the outbreak. Peripartum women appear to be another population susceptible to CDI.

scholarly journals Emergence and Control of Fluoroquinolone-Resistant, Toxin A–Negative, Toxin B–PositiveClostridium difficile

2007 ◽  
Vol 28 (8) ◽  
pp. 932-940 ◽  
Author(s):  
Denise Drudy ◽  
Norma Harnedy ◽  
Séamus Fanning ◽  
Margaret Hannan ◽  
Lorraine Kyne
Keyword(s):  
Infection Control ◽  
Antibiotic Use ◽  
Control Measures ◽  
Prescribing Practices ◽  
Toxin A ◽  
Toxin B ◽  
Environmental Cleaning ◽  
Infection Control Measures ◽  
Patient Admissions ◽  
Antimicrobial Susceptibility Tests

Background.Clostridium difficileis a major cause of infectious diarrhea in hospitalized patients. Between August 2003 and January 2004, we experienced an increase in the incidence ofC. difficile–associated disease. We describe the investigation into and management of the outbreak in this article.Methods.A total of 73 consecutive patients with nosocomialC. difficile–associated diarrhea were identified.C. difficileisolates were characterized using toxin-specific enzyme immunoassays, a tissue-culture fibroblast cytotoxicity assay, polymerase chain reaction (PCR), and antimicrobial susceptibility tests. Rates of recurrence and ofC. difficilecolitis were recorded. Changes in antibiotic use and infection control policies were documented.Results.The incidence ofC. difficile–associated diarrhea peaked at 21 cases per 1,000 patient admissions. Of theC. difficileisolates recovered, 85 (95%) were identical toxin A–negative and toxin B-positive strains, corresponding to toxinotype VIII and PCR ribotype 017. All clonal isolates were resistant to multiple antibiotics, including ofloxacin, ciprofloxacin, levofloxacin, moxifloxacin, and gatifloxacin (minimum inhibitory concentrations [MICs] of greater than 32μg/mL) and erythromycin, clarithromycin, and clindamycin (MICs of greater than 256μg/mL). RecurrentC. difficile–associated disease occurred in 26 (36%) of the patients. At least 10 (14%) of the patients developedC. difficilecolitis. Additional infection control measures introduced included the use of ward memos, a hand-hygiene awareness campaign, increased environmental cleaning, attention to prescribing practices for antibiotics, increased awareness of diarrheal illness, and early isolation of affected patients. Total use of fluoroquinolones did not change throughout the study period. Despite persistence of this toxin-variant strain, the incidence ofC. difficile–associated disease in our institution decreased to fewer than 5 cases per 1,000 admissions.Conclusions.We report on the emergence of a fluoroquinolone- and clindamycin-resistant, toxin A–negative, and toxin B–positive strain ofC. difficileassociated with an outbreak ofC. difficile–associated disease in our institution during a 6-month period. We found that careful attention to improvement of infection control interventions was the most important means of controlling this nosocomial pathogen.

scholarly journals Decreasing Prevalence of Multidrug-Resistant Acinetobacter Baumannii in Rīga East University Hospital / Multirezistentās Acinetobacter Baumannii Izplatības Mazināšanās Rīgas Austrumu Klīniskajā Universitātes Slimnīcā

2016 ◽  
Vol 70 (4) ◽  
pp. 232-236
Author(s):  
Māris Liepiņš ◽  
Raimonds Sīmanis ◽  
Aivars Lejnieks
Keyword(s):  
Infection Control ◽  
Acinetobacter Baumannii ◽  
Venous Catheter ◽  
Multidrug Resistant ◽  
Control Measures ◽  
University Hospital ◽  
Hospital Environment ◽  
Central Venous ◽  
Infection Control Measures ◽  
Time Period

Abstract There has been an increasing tendency of infections caused by multidrug-resistant organisms (MDRO), including multidrug-resistant Acinetobacter baumannii (MDRAB), in the Rīga East University Hospital (REUH) during the last decade. Over the last two years (2014-2015), this tendency has reversed and the prevalence of MDRAB has decreased considerably. In this study we assessed the prevalence of MDRAB in intensive care units (ICUs), internal medicine, surgery units and analysed antibiotic sensitivity profiles. In addition, we determined if current infection control measures are preventing further increase of infections caused by MDRAB in REUH. Retrospective Acinetobacter baumannii prevalence data were collected for the period from 2009 until 2012. For the time period from the beginning of 2013 until 2015, after implementing such infection control measures as control of compliance to hand hygiene guidelines, a review of central venous catheter insertion protocols and regular search for sources of MDRAB in hospital environment, prospective follow-up of new cases was conducted. Antimicrobial sensitivity profiles were assessed for the period from 2013 until 2015. Data were processed with the statistical software WHONET 5.5. Bacteria identification and antibiotic susceptibility testing were performed by VITEK 2 compact, BioMerieux, France. The prevalence of MDRAB in the period 2009 to 2013 increased from 71 to 217 cases per year, but from between 2013 (time of implementing infection control measures) and 2015 it decreased to 113 cases in 2015. In the three year period (2013-2015), the proportion of MDRAB causing bloodstream infections (BSI) and central nervous system infections (CNSI) was 15.85% from all identified MDRAB cases. Of the 113 MDRAB infections diagnosed in 2015, BSI was found in 16.81% cases (n = 19). Antibiotic resistance testing showed that colistin is the most effective drug against MDRAB. The majority of Acinetobacter baumannii isolates were resistant to Ampicillin/Sulbactam, Piperacillin/Tazobactam, Ceftazidime, Cefepime, Imipenem, Meropenem, Amikacin, Gentamicin, Tobramycin, and Ciprofloxacin. Over the last two years (2014-2015), prevalence of MDRAB infections decreased considerably. In the time period from 2013 to 2014, resistance of Acinetobacter baumannii increased to imipenem, ciprofloxacin and colistin, while decreased slightly to amikacin. Rigorous infection control measures, such as identification and elimination of new MDRAB sources in environment, review of the central venous catheter insertion protocol and improvements in hand hygiene, are crucial for decreasing distribution of and invasive infections caused by MDRAB in the hospital environment.

Completely Resistant Acinetobacter baumannii Strains

2002 ◽  
Vol 23 (8) ◽  
pp. 477-479 ◽  
Author(s):  
Siham Mahgoub ◽  
Jimi Ahmed ◽  
Aaron E. Glatt
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Acinetobacter Baumannii ◽  
Broad Spectrum ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Control Measures ◽  
Teaching Hospitals ◽  
Infection Control Measures

Abstract Nosocomially acquired completely resistant Acinetobacter baumannii strains are a major clinical concern. We identified completely resistant A. baumannii in 6 (4.9%) of 122 A. baumannii isolates in a retrospective chart review at two teaching hospitals. All of these patients had received broad-spectrum antibiotics and had severe underlying comorbid illnesses, long hospitalizations, or recent surgical procedures; 3 had been in the intensive care unit. Five (83%) of the 6 patients were older than 70 years. Only one death occurred. Strict infection control measures may limit further spread.

scholarly journals 2460. Hospital-Wide Outbreak of Serratia marcescens of Unclear Source: When Extensive Infection Control Measures Are Needed

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S852-S852
Author(s):  
Ralph Tayyar ◽  
Carol Weyhmuller ◽  
Caitlin Fasano ◽  
Jad Aridi ◽  
Eileen Sherman ◽  
...  
Keyword(s):  
Infection Control ◽  
Serratia Marcescens ◽  
Water System ◽  
Positive Culture ◽  
Control Measures ◽  
Important Lesson ◽  
Infection Control Measures ◽  
Department Of Health ◽  
Water Cleaning ◽  
Susceptibility Profiles

Abstract Background Nosocomial outbreaks of Serratia marcescens have been widely reported and the source is identified in most cases. We report a Serratia marcescens outbreak in a community hospital with no obvious source. Methods An epidemiologic investigation was started after an outbreak was suspected. Clinical data were collected from charts of patients with positive culture for Serratia marcescens. Molecular relatedness of available isolates was determined by pulsed-field gel electrophoresis. Results Between December 2016 and August 2017, 13 non-pigmented Serratia marcescens isolates were identified from 11 patients. Bacteria were isolated from blood, abdominal and respiratory cultures. Susceptibility profiles showed variable resistance to ceftriaxone, ceftazidime, imipenem, tobramycin and aztreonam. Infection control measures: Isolates were identified from adult patients who underwent various cardiothoracic/vascular surgeries. Patients were traced back to a single floor of the new hospital building. To control this outbreak, the infection prevention team started with hand hygiene initiatives and observations, environmental sampling, and reviewing management of ventilator, dialysis equipment, and ECMO machines. Ice machine carbonless filters were installed, UV disinfection systems were used, and new TEE cleaning rooms were designated. In conjunction with recommendations of department of health, hospital was contracted with a water cleaning company; laminar flow aerators were installed, water sampling plan was implemented and ultimately the whole building’s water system was hyper-chlorinated. Conclusion While water contamination was the most likely source, a specific cause could not be identified. An important lesson learnt is the quick implementation of infection control measures after identifying infected patients is key in controlling an outbreak. Disclosures All authors: No reported disclosures.

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