Colonization of long term care facility patients with MDR-Gram-negatives during an Acinetobacter baumannii outbreak

Abstract

BackgroundWe aimed to determine the prevalence of colonization by multidrug-resistant Gram-negative bacteria including ESBL-producing enterobacteriaceae, carbapenem-resistant enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii at two wards caring long term for patients with disorder of consciousness at the Geriatric Health Centers Graz, Austria. During our study we detected two A. baumannii outbreaks.MethodsIn August 2015, we conducted a point-prevalence study. Inguinal and perianal swabs were taken from 38 patients and screened for multidrug-resistant Gram-negative rods using standard procedures. Six months after the initial investigation all patients were sampled again and use of antibiotics during the past 6 months and mortality was registered. Genetic relatedness of bacteria was evaluated by DiversiLab system.ResultsFifty percent of patients were colonized by multidrug-resistant Gram-negative isolates. Five patients harboured ESBL-producing enterobacteriaceae. No carbapenem-resistant enterobacteriaceae were detected. 13/38 patients were colonized by A. baumannii isolates (resistant to ciprofloxacin but susceptible to carbapenems). There was a significant difference in the prevalence of colonization by A. baumannii between ward 2 and ward 1 (60% vs. 5.6%, p < 0.001). Two clusters of A. baumannii isolates were identified including one isolate detected on a chair in a patient’s room.ConclusionsWe detected a high prevalence of two multidrug-resistant A. baumannii strains in patients with disorder of consciousness at a LTCF in Graz, Austria. Our findings strongly suggest nosocomial cross-transmission between patients. An active surveillance strategy is warranted to avoid missing newly emerging pathogens.

Antibiotic-resistant pathogens in different patient settings and identification of surveillance gaps in Switzerland – a systematic review

“…Looking at neighbouring countries, data from LTCFs in Italy show that the prevalence of ESBL-producers and CPE is as high as 64% and 6%, respectively [71, 72]. A point prevalence study from 2015 performed in an Austrian LTCF reported a prevalence of 13% for ESBL, whereas no CPE were found [73]. In Germany, data from 2012 among nursing home residents showed a prevalence of 27% for ESBL, 9% for MRSA and 3% for VRE [74].…”

Investigation of Acinetobacter baumannii Activity in Vascular Surgery Units through Epidemiological Management Based on the Analysis of Antimicrobial Resistance, Biofilm Formation and Genotyping

“…After analysis of the data available, PUS patient was most probably the source of the IO. It appears that the transmission of Acinetobacter strains and the development of epidemic outbreaks in hospitals may also result from transferring patients between departments [12,58]. In the situation analyzed by us, the patient rotation in the department of vascular surgery and hospitalization of patients in different units, e.g., transferring patients from the ICU to the department of vascular surgery (PUS patient), resulted in contact between patients qualified for IO and IIO.…”

“…It is also generally accepted that A. baumannii clones do not demonstrate such great and rapid variability as other microorganisms causing hospital epidemics (MRSA, VRE) [12,59,60]. Epidemic outbreaks caused by the same epidemic clone of A. baumannii, which occurred in long intervals (of over several months), had been described before [12,61].…”

“…resistant to carbapenems, fluoroquinolones and aminoglycosides constitute 62.9%, which puts our country among several European countries with a high percentage of resistant strains (Latvia 56.8%, Bulgaria 66.4%, Italy 75.7%, Romania 77.6%, Cyprus 78.2%, Greece 81.3%, Lithuania 85.1%, Croatia 90.8%) [8]. Pandrug resistant bacteria (PDR) and XDR isolates of A. baumannii have been reported for many years, not only in Polish hospitals, but also globally [9][10][11][12][13]. Infections caused by these strains are a serious therapeutic issue and are particularly common among intensive care unit (ICU) patients, but also appear in people hospitalized in other departments [14][15][16][17][18][19].…”

Effect of a Multispecies Probiotic on Intestinal and Skin Colonization by Multidrug-Resistant Gram-Negative Bacteria in Patients in a Long-Term Care Facility: A Pilot Study

“…Furthermore, clinical observations by one of the authors (M.S.) suggested efficacy of Omnibiotic10 AAD ® in eliminating colonization by multidrug-resistant Acinteobacter baumannii isolates following an outbreak [ 24 ].…”