Cross-Transmission of Multidrug-ResistantAcinetobacter baumanniiClonal Strains Causing Episodes of Sepsis in a Trauma Intensive Care Unit

2008 ◽  
Vol 29 (5) ◽  
pp. 410-417 ◽  
Author(s):  
Antonios Markogiannakis ◽  
George Fildisis ◽  
Sofia Tsiplakou ◽  
Alexandras Ikonomidis ◽  
Alexandra Koutsoukou ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Environmental Samples ◽  
Genetic Relatedness ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Modes Of Transmission ◽  
Care Workers ◽  
Cross Transmission ◽  
Successful Control

Objective.To investigate the mode of transmission of imipenem-resistantAcinetobacter baumanniistrains causing episodes of sepsis.Setting.A 7-bed trauma intensive care unit (ICU) in an orthopedic hospital in Greece.Design.During a 14-week period (from January 10 to April 16, 2006), clinical specimens, along with samples taken on a weekly basis from the ICU environment and from the hands of health care workers (HCWs), were prospectively tested for imipenem-resistantA. baumannii.Pulsed-field gel electrophoresis was used to study the genetic relatedness of the isolates recovered from these specimens and samples.Results.During the survey, imipenem-resistantA. baumanniiwas identified in 14 hospitalized patients, from whom 40 multidrug-resistant and imipenem-resistantA. baumaniiisolates were recovered. These pathogens caused episodes of bacteremia and sepsis in all but one of the patients and contributed to the death of 3 patients. Samples for culture were obtained from the environment and from the hands of HCWs; 29 imipenem-resistantA. baumanniiisolates were recovered from the environment, and 12 from HCWs. One predominant genotype and 2 less predominant genotypes were detected among the 81 imipenem-resistantA. baumanniiisolates. All 3 of these genotypes were found among patients and HCWs and were recovered from environmental samples.Interventions.Control measures consisted of the closure of the ICU and the transfer of the patients to other units. The ICU was disinfected, and adherence to proper hand hygiene protocol was reinforced. These same clonal isolates were not recovered from clinical or environmental samples during the month after the reopening of the ICU.Conclusions.The extensive dissemination of imipenem-resistantA. baumanniiclonal strains causing episodes of bacteremia and/or sepsis resulted from modes of transmission via multiple contaminated surfaces and objects and transiently colonized HCWs' hands. Closure of the ICU and its meticulous environmental decontamination led to the successful control of the outbreak.

scholarly journals Impact of environmental cleaning on the colonization and infection rates of multidrug-resistant Acinetobacter baumannii in patients within the intensive care unit in a tertiary hospital

2020 ◽  
Author(s):  
Yang Li ◽  
Hai Ge ◽  
Hui Zhou ◽  
Wanqing Zhou ◽  
Jie Zheng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Acinetobacter Baumannii ◽  
Clearance Rate ◽  
Genetic Relatedness ◽  
Multidrug Resistant ◽  
Fluorescence Labeling ◽  
Infection Rates ◽  
Environmental Cleaning

Abstract Objective: To continuously evaluate the effect of environmental cleaning on the colonization and infection rates of multidrug-resistant Acinetobacter baumannii (MDR-AB) in the patients within an intensive care unit (ICU). Methods: Environmental cleaning on the high-touch clinical surfaces (HTCS) within a comprehensive ICU was evaluated through monitoring fluorescent marks when the overall compliance with hand hygiene during 2013-2014 was monitored. Meanwhile, samples from the HTCS and inpatients were collected and sent for bacterial culture and identification. The drug susceptibility testing was further implemented to monitor the prevalence of MDR-AB. The genetic relatedness of MDR-AB collected either from the HTCS or inpatients was analyzed by pulsed field gel electrophoresis (PFGE) when an outbreak was doubted. Results: The overall compliance with hand hygiene remained relatively stable during 2013-2014. Under this circumstance, the clearance rate of fluorescence marks on the environmental surfaces within ICUs significantly increased from 21.9% to 85.7%, and accordingly the colonization and infection rates of MDR-AB decreased from 16.5‰ to 6.6‰ and from 7.4‰ to 2.8‰, respectively, from the beginning to the end of 2013. However, during the year 2014, because of frequent change and movement of cleaning workers, the clearance rate of fluorescence marks decreased below 50%, and the overall colonization and infection rates of MDR-AB correspondingly increased from 9.1‰ to 11.1‰ and from 1.5‰ to 3.9‰, respectively. PFGE displayed a high genetic relatedness between the MDR-AB strains analyzed, indicating a dissemination of MDR-AB during the surveillance period. Conclusion. For the easily disseminated MDR-AB within ICUs , the clearance rates of fluorescence labeling on HTCS is negatively corelated with the hospital infection rates of MDR-AB. Such an invisible fluorescence labelling is an effective and convenient method to continuously monitor cleanness of medical environment within hospitals.

scholarly journals Endemicity ofAcinetobacter calcoaceticus-baumanniiComplex in an Intensive Care Unit in Malaysia

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Amreeta Dhanoa ◽  
Ganeswrie Rajasekaram ◽  
Soo Sum Lean ◽  
Yuet Meng Cheong ◽  
Kwai Lin Thong
Keyword(s):  
Intensive Care ◽  
Genetic Relatedness ◽  
Acinetobacter Calcoaceticus ◽  
Opportunistic Pathogen ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Effective Control ◽  
Icu Patients ◽  
Infection Control Measures ◽  
High Degree

Introduction.Acinetobacter calcoaceticus-baumanniicomplex (ACB complex) is a leading opportunistic pathogen in intensive care units (ICUs). Effective control of spread requires understanding of its epidemiological relatedness. This study aims to determine the genetic relatedness and antibiotic susceptibilities of ACB complex in an ICU in Malaysia.Methodology. Pulsed field gel electrophoresis (PFGE), E-test, and disk diffusion were used for isolates characterization.Results. During the study period (December 2011 to June 2012), 1023 patients were admitted to the ICU and 44 ACB complex (blood,n=21, and blind bronchial aspirates,n=23) were recovered from 38 ICU patients. Six isolates were from non-ICU patients. Of the 44 ICU isolates, 88.6% exhibited multidrug-resistant (MDR) patterns. There was high degree of resistance, with minimum inhibitory concentration90(MIC90) of >32μg/mL for carbapenems and ≥256μg/mL for amikacin, ampicillin/sulbactam, and cefoperazone/sulbactam. Isolates from the main PFGE cluster were highly resistant. There was evidence of dissemination in non-ICU wards.Conclusion. High number of clonally related MDR ACB complex was found. While the ICU is a likely reservoir facilitating transmission, importation from other wards may be important contributor. Early identification of strain relatedness and implementation of infection control measures are necessary to prevent further spread.

Surveillance of multidrug-resistant gram-negative bacilli in a neonatal intensive care unit: prominent role of cross transmission

2007 ◽  
Vol 35 (4) ◽  
pp. 222-230 ◽  
Author(s):  
Caterina Mammina ◽  
Paola Di Carlo ◽  
Domenico Cipolla ◽  
Mario Giuffrè ◽  
Alessandra Casuccio ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Gram Negative ◽  
Cross Transmission

Successful control of 2 simultaneous outbreaks of OXA-48 carbapenemase-producing Enterobacteriaceae and multidrug-resistant Acinetobacter baumannii in an intensive care unit

2017 ◽  
Vol 45 (12) ◽  
pp. 1356-1362 ◽  
Author(s):  
A. Robustillo-Rodela ◽  
V. Pérez-Blanco ◽  
M.A. Espinel Ruiz ◽  
G. Ruiz Carrascoso ◽  
J.C. Figueira Iglesias ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Multidrug Resistant ◽  
Successful Control

scholarly journals What Healthcare Workers Should Know about Environmental Bacterial Contamination in the Intensive Care Unit

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Vincenzo Russotto ◽  
Andrea Cortegiani ◽  
Teresa Fasciana ◽  
Pasquale Iozzo ◽  
Santi Maurizio Raineri ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Healthcare Workers ◽  
Uv Light ◽  
Bacterial Species ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Major Health Problem ◽  
Resistant Species ◽  
Increased Risk

Intensive care unit- (ICU-) acquired infections are a major health problem worldwide. Inanimate surfaces and equipment contamination may play a role in cross-transmission of pathogens and subsequent patient colonization or infection. Bacteria contaminate inanimate surfaces and equipment of the patient zone and healthcare area, generating a reservoir of potential pathogens, including multidrug resistant species. Traditional terminal cleaning methods have limitations. Indeed patients who receive a bed from prior patient carrying bacteria are exposed to an increased risk (odds ratio 2.13, 95% confidence intervals 1.62–2.81) of being colonized and potentially infected by the same bacterial species of the previous patient. Biofilm formation, even on dry surfaces, may play a role in reducing the efficacy of terminal cleaning procedures since it enables bacteria to survive in the environment for a long period and provides increased resistance to commonly used disinfectants. No-touch methods (e.g., UV-light, hydrogen peroxide vapour) are under investigation and further studies with patient-centred outcomes are needed, before considering them the standard of terminal cleaning in ICUs. Healthcare workers should be aware of the role of environmental contamination in the ICU and consider it in the broader perspective of infection control measures and stewardship initiatives.

An Outbreak of Carbapenem-Resistant Acinetobacter baumannii Infection in a Neonatal Intensive Care Unit: Investigation and Control

2011 ◽  
Vol 32 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Eric J. McGrath ◽  
Teena Chopra ◽  
Nahed Abdel-Haq ◽  
Katherine Preney ◽  
Winston Koo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Neonatal Intensive Care Unit ◽  
Acinetobacter Baumannii ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Carbapenem Resistant ◽  
Surveillance Cultures

Objective.To investigate the mode of transmission of and assess control measures for an outbreak of carbapenem-resistant (multidrug-resistant) Acinetobacter baumannii infection involving 6 premature infants.Design.An outbreak investigation based on medical record review was performed for each neonate during the outbreak (from November 2008 through January 2009) in conjunction with an infection control investigation.Setting.A 36-bed, level 3 neonatal intensive care unit in a university-affiliated teaching hospital in Detroit, Michigan.Interventions.Specimens were obtained for surveillance cultures from all infants in the unit. In addition, geographic cohorting of affected infants and their nursing staff, contact isolation, re-emphasis of adherence to infection control practices, environmental cleaning, and use of educational modules were implemented to control the outbreak.Results.Six infants (age, 10-197 days) with multidrug-resistant A. baumannii infection were identified. All 6 infants were premature (gestational age, 23-30 weeks) and had extremely low birth weights (birth weight, 1000 g or less). Conditions included conjunctivitis (2 infants), pneumonia (4 infants), and bacteremia (1 infant). One infant died of causes not attributed to infection with the organism; the remaining 5 infants were discharged home. All surveillance cultures of unaffected infants yielded negative results.Conclusions.The spread of multidrug-resistant A. baumannii infection was suspected to be due to staff members who spread the pathogen through close contact with infants. Clinical staff recognition of the importance of multidrug-resistant A. baumannii recovery from neonatal intensive care unit patients, geographic cohorting of infected patients, enhanced infection control practices, and staff education resulted in control of the spread of the organism.

Outbreak of Multidrug-ResistantPseudomonas aeruginosaColonization and Infection Secondary to Imperfect Intensive Care Unit Room Design

2009 ◽  
Vol 30 (1) ◽  
pp. 25-33 ◽  
Author(s):  
Susy Hota ◽  
Zahir Hirji ◽  
Karen Stockton ◽  
Camille Lemieux ◽  
Helen Dedier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Genetic Relatedness ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Care Hospital ◽  
Fluorescent Marker ◽  
Design Elements ◽  
Room Design ◽  
Surrounding Areas

Background.Pseudomonas aeruginosahas been increasingly recognized for its ability to cause significant hospital-associated outbreaks, particularly since the emergence of multidrug-resistant strains. Biofilm formation allows the pathogen to persist in environmental reservoirs. Thus, multiple hospital room design elements, including sink placement and design, can impact nosocomial transmission ofP. aeruginosaand other pathogens.Methods.From December 2004 through March 2006, 36 patients exposed to the intensive care unit or transplant units of a tertiary care hospital were infected with a multidrug-resistant strain ofP. aeruginosa. All phenotypically similar isolates were examined for genetic relatedness by means of pulsed-field gel electrophoresis. Clinical characteristics of the affected patients were collected, and a detailed epidemiological and environmental investigation of potential sources was carried out.Results.Seventeen of the infected patients died within 3 months; for 12 (71%) of these patients, infection with the outbreak organism contributed to or directly caused death. The source of the outbreak was traced to hand hygiene sink drains, where biofilms containing viable organisms were found. Testing by use of a commercial fluorescent marker demonstrated that when the sink was used for handwashing, drain contents splashed at least 1 meter from the sink. Various attempts were made to disinfect the drains, but it was only when the sinks were renovated to prevent splashing onto surrounding areas that the outbreak was terminated.Conclusion.This report highlights the importance of biofilms and of sink and patient room design in the propagation of an outbreak and suggests some strategies to reduce the risks associated with hospital sinks.

Ralstonia mannitolilytica sepsis in neonatal intensive care unit – Be(a)ware of the multidrug resistant nosocomial bug

2021 ◽  
pp. 004947552110365
Author(s):  
Usha Devi Rajendran ◽  
Subha Sundaramoorthy ◽  
Giridhar Sethuraman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Environmental Samples ◽  
Neonatal Intensive Care ◽  
Early Recognition ◽  
Opportunistic Pathogen ◽  
Multidrug Resistant ◽  
Clinical Deterioration ◽  
Extremely Low Birth Weight ◽  
Fast Recovery

Ralstonia mannitolilytica, an emerging opportunistic pathogen is rarely isolated in neonatal units. We have elaborated our experience of managing its recent septic outbreak affecting four neonates in our intensive care unit over a span of five days. Three of the four had extremely low birth weight and had secondary clinical deterioration in the form of recurrent apnoea requiring intubation. All had thrombocytopenia. Their median age at clinical deterioration was 8 (4–12) days. The organism was multidrug resistant, but uniformly sensitive to flouroquinolones and co-trimoxazole, on which all recovered. Environmental samples were negative for the organism. There were no further positive cases. Early recognition and appropriate choice of drug will aid in fast recovery.

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