An outbreak of Acinetobacter baumannii septicemia in a neonatal intensive care unit of a university hospital in Brazil

Abstract

We studied an outbreak of two multi-drug resistant clones of Acinetobacter baumannii in the Neonatal Intensive Care Unit of the Uberlândia Federal University Hospital in Minas Gerais state, Brazil, and we analyzed the contribution of cross-transmission in the rise in infection rates. Eleven neonates who developed multi-drug resistant A. baumannii nosocomial infection were matched to 22 neonates who were admitted to the same unit and did not develop an infection during the outbreak period, in order to identify risk factors for infection. Three out of the 11 neonates died. Epidemiological investigation included molecular typing, using pulsed field gel electrophoresis. Prior to the outbreak, from December 2001 to March 2002, no case of infection by this microorganism was diagnosed. Environmental and healthcare worker hand cultures were negative. Nine isolates had similar pulsed field gel electrophoresis patterns and two had another clone. The first clone was brought into the unit by an infected patient who was transferred from another hospital without a history of antibiotic use. The second clone did have its origin clearly defined. Both infected groups led us to conclude that several factors contributed to infection with A. baumannii. These factors were: exposure to antibiotics and invasive devices, birth weight ≤ ≤ ≤ ≤ ≤ 1500g, age ≤ ≤ ≤ ≤ ≤ 7 days and duration of hospitalization ≥ ≥ ≥ ≥ ≥ 7 days. Based on logistic regression, infected neonates were more exposed to carbapenem and mechanical ventilation than the control group. Cross transmission between infants contributed to the rise in the rates of multi-drug resistant A. baumannii infection.

Clinical and microbiological profile of babies born with risk of neonatal sepsis

“…A study from Pakistan reported that prematurity and LBW are associated with increasing risk of Acinetobacter infection in neonates (22). Additionally, the use of the central venous catheter and mechanical ventilation were identified as significant risk factors for neonatal Acinetobacter baumannii septicemia in a Brazilian study (23). …”

Prevalence, antimicrobial susceptibility profiles and case fatality rates of Acinetobacter Baumannii sepsis in a neonatal unit

“…Risk factors identified for the development of A. baumannii infection include prematurity, very-lowbirth-weight, postnatal age <7 days, mechanical ventilation, use of central venous catheters, as well as prior broad spectrum antibiotic use [12,13]. The mortality rates associated with A. baumannii infections in neonates range from 14% to 80% [12,13,19,24]. Number of reports on epidemiology of A. baumannii in neonates are often from developed countries yet nosocomial sepsis is more common in developing countries.…”

Control of an Acientobacter baumannii outbreak in a neonatal ICU without suspension of service: a devastating outbreak in Diyarbakir, Turkey

“…Discontinuation of the use of the bandage brought the outbreak to an end [14]. A Brazilian study proved that greater use of carbapenem and MV were significant factors in the nosocomial A. baumannii outbreak under investigation [15]. In a Greek study, recent ventilator-associated pneumonia due to carbapenem-resistant A. baumannii (CRAB) was found to be independently associated with CRAB bacteremia acquisition [16].…”

“…PFGE continues to be a powerful tool for a better understanding of the epidemiology of a nosocomial outbreak [14,15]. An identical clone of A. baumannii was isolated from the blood of neonates hospitalized in our NICU during the study period from HCWs' hands, and from environmental samples.…”