Failure to Communicate: Transmission of Extensively Drug-Resistantbla_OXA-237-ContainingAcinetobacter baumannii—Multiple Facilities in Oregon, 2012–2014

Abstract

OBJECTIVE To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii. DESIGN Outbreak investigation. SETTING AND PARTICIPANTS Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals. METHODS A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed. RESULTS We identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n = 8), or skilled nursing facility A (n = 8), or both (n = 1) prior to XDR A. baumannii isolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase gene blaOXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission. CONCLUSIONS Interfacility transmission of XDR A. baumannii carrying the rare blaOXA-237 was facilitated by transfer of affected patients without communication to receiving facilities.

Nosocomial Outbreak of Extensively Drug-Resistant Acinetobacter baumannii Isolates Containing bla OXA-237 Carried on a Plasmid

“…The surveillance source was axillary/groin. The A. baumannii isolates were initially selected due to their high-level carbapenem resistance and were a subset of 21 cases identified during this study (13). These 16 isolates were physically available for further molecular characterization.…”

“…Setting and selection of isolates. Sixteen A. baumannii isolates carrying bla OXA-237 reported in this study were initially selected due to their high-level carbapenem resistance and were a subset of 21 cases identified during this study (13). The bla OXA-237 -positive A. baumannii AF684 strain was included as a control for comparison purposes (9).…”

“…OHA reviewed all three cases and identified a common health care facility: SNF-A. In response, OHA launched a 2-year investigation, as fully described by Buser et al (13). During the next 2 years, 13 other isolates, all XDR A. baumannii, were collected and available for molecular analysis (Fig.…”

Phage Therapy as a Promising New Treatment for Lung Infection Caused by Carbapenem-Resistant Acinetobacter baumannii in Mice

“…In the last 10 years, Acinetobacter baumannii has emerged as one of the major pathogens implicated in outbreaks of hospital-acquired infections, especially in patients from intensive care units (ICUs; Maragakis and Perl, 2008 ; Eveillard et al, 2010 ; Buser et al, 2017 ). Historically, carbapenems are the most potent and reliable β-lactam antibiotics for the treatment of serious infections caused by A. baumannii ( Garnacho-Montero and Amaya-Villar, 2010 ).…”

Investigation of a Carbapenemase-producing Acinetobacter baumannii outbreak using whole genome sequencing versus a standard epidemiologic investigation

“…Secondly, this study represents the third reported identification of the acquired class D carbapenemase bla OXA-237 , and its first identification in Canada. The bla OXA-235-like subclass, which includes bla OXA-237 , was first recognised from A. baumannii isolates in the United States and Mexico in 2013 [ 34 ] and was implicated in a multi-center outbreak in Oregon between 2012 and 2014 [ 35 ]. This resistance gene was located on a plasmid found in the most prominent A. baumannii clonal group, representing a potential for extensive dissemination [ 36 ].…”