Investigation of a Multiyear Multiple Critical Care Unit Outbreak Due to Relatively Drug-Sensitive Acinetobacter baumannii: Risk Factors and Attributable Mortality

Kaul, Rupert; Burt, J.; Cork, Lynda; Dedier, Helen; Garcia, M Leni; Kennedy, Catharine; Brunton, James; Krajden, Mel; Conly, John

doi:10.1093/infdis/174.6.1279

Cited by 65 publications

(30 citation statements)

References 47 publications

(46 reference statements)

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“…IRAB was isolated from 104 patients, and ISAB was isolated from 387 patients between January and December 2000. The risk factors for IRAB were a previous intensive care unit (ICU) Acinetobacter baumannii strains are becoming increasingly important nosocomial pathogens (3), especially in intensive care units (ICUs), where outbreaks due to this microorganism have been reported (2,5,11). A particular concern has been the frequent multiple antimicrobial resistances exhibited (12,13,14,16).…”

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confidence: 99%

Risk Factors for Acquisition of Imipenem-Resistant Acinetobacter baumannii : a Case-Control Study

Lee

Kim

Choi

et al. 2004

Antimicrob Agents Chemother

155

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Risk factors for the nosocomial occurrence of imipenem-resistant Acinetobacter baumannii (IRAB) were determined. A case-control study design was used for a comparison of two groups of A. baumannii-positive patients with control patients. Nosocomial IRAB was isolated from the first group of A. baumannii-positive patients, and imipenem-susceptible A. baumannii (ISAB) was isolated from the second group. The control patients were randomly selected in a 4:1 ratio from the same medical or surgical services from which the A. baumannii-positive patients were receiving care when the isolation of IRAB occurred. Risk factors analyzed included demographic variables, comorbid conditions, variables related to hospitalization, and the antimicrobials used. IRAB was isolated from 104 patients, and ISAB was isolated from 387 patients between January and December 2000. The risk factors for IRAB were a previous intensive care unit (ICU) Acinetobacter baumannii strains are becoming increasingly important nosocomial pathogens (3), especially in intensive care units (ICUs), where outbreaks due to this microorganism have been reported (2,5,11). A particular concern has been the frequent multiple antimicrobial resistances exhibited (12,13,14,16). Imipenem and meropenem have retained in vitro activities that are superior to those of other antimicrobials, and in many centers, they are the drug of choice for patients with infections caused by A. baumannii (3). Unfortunately, recent analyses of hospital outbreaks have documented the spread of imipenem-resistant strains (6,8,17). This emergence of imipenem-resistant A. baumannii (IRAB) has become a worldwide problem and a troublesome development that threatens the continued successful treatment of Acinetobacter species infections (1).In our institution, the first case of IRAB bacteremia was detected in August 1997. There was only one case of IRAB bacteremia each year between 1997 and 1998; however, the number of cases increased to five in 1999 and four in 2000. Four cases were in medical wards, three were in the medical ICU, one was in a surgical ward, and three were in surgical ICUs. Since November 2000, we have performed surveillance cultures at ICU admission and isolated patients with multidrug-resistant A. baumannii. As cases of IRAB infection or colonization increased, we reinforced a combination of control measures, such as equipment decontamination, strict attention to hand washing, and isolation procedures. In addition, since March 2001, the use of imipenem has been restricted by requiring approval from an infectious disease specialist.The aim of this study was to identify risk factors for the nosocomial occurrence of IRAB and to contrast those factors with those for imipenem-susceptible A. baumannii (ISAB). Potential risk factors of particular interest were a previous stay in an ICU and antimicrobial drug exposures. The rationale for the study was that previous studies with the same aim had involved smaller numbers of A. baumannii culture-positive patients, thereby limiting the ab...

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confidence: 99%

Risk Factors for Acquisition of Imipenem-Resistant Acinetobacter baumannii : a Case-Control Study

Lee

Kim

Choi

et al. 2004

Antimicrob Agents Chemother

155

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“…Risk factors associated with these infections include antibiotic exposure, length of stay in intensive care units, mechanical ventilations, and severity of underlying illness (1,7,9,11,21,23,39). Hospitalized patients can become "colonized" with Acinetobacter species, which may cause endemic problems in the hospital setting due to cross-transmission between patients (7,11,23). Acinetobacter species have been isolated from cases of pneumonia (6.9%), bloodstream infections (2.4%), surgical site infections (2.1%), and urinary tract infections (1.6%) according to U.S. National Nosocomial Infections Surveillance data from hospitals in 2003 (15).…”

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confidence: 99%

Acinetobacter septicus sp. nov. Association with a Nosocomial Outbreak of Bacteremia in a Neonatal Intensive Care Unit

Kılıç¹,

Li²,

Mellmann³

et al. 2008

J Clin Microbiol

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Acinetobacter species other than Acinetobacter baumannii have rarely been reported to be associated with nosocomial outbreaks of bloodstream infections. Within a period of 1 week, seven Acinetobacter-like isolates were recovered from peripheral blood and catheter specimens of five patients at a neonatal intensive care unit (NICU) in a tertiary hospital in Turkey. All five patients had placement of central venous catheters and had received total parenteral nutrition before the onset of bacteremia. Two of the five patients died. Medical devices, tap water, aerators, water samples, various surfaces, intravenous fluids, and the hands of health care workers in the NICU were sampled and were culture negative for the bacterium. All seven of the isolates had identical biochemical reactions, antimicrobial susceptibility results, and pulsed-field gel electrophoresis patterns, indicating a clonal nosocomial outbreak. A panel of standard biochemical reaction profiles and three phenotypic commercial identification systems failed to identify these isolates. Phenotypically, the isolate differed from Acinetobacter ursingii by its hemolysis on sheep blood agar and its negative citrate utilization. Sequences of the full 16S rRNA gene, which contained at least three different gene copies with polymorphic sequences between nucleotide positions 70 and 206, were determined from the first recovered isolate. The complete 1,529-to 1,531-bp 16S rRNA gene sequences and partial 801-bp rpoB gene sequences had similarities of 99.5% and 97.2%, respectively, to an A. ursingii isolate. The DNA-DNA similarities of the strain against the type strain of A. ursingii were 64.7 and 68.7%, which were lower than the recommended threshold value of 70% for the definition of bacterial species. These data indicate that a novel Acinetobacter organism caused the nosocomial outbreak of bacteremia in the NICU unit. We propose the designation of Acinetobacter septicus sp. nov. for these isolates, with isolate AK001 as the type strain.

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“…The Gram-negative bacilli that were most frequently isolated included A. baumannii, K. pneumoniae and P. aeruginosa. The high isolation rate of A. baumannii and P. aeruginosa is interesting, given that these are well-known HAP pathogens (21)(22)(23)(24), but uncommonly involved in CAP. K. pneumoniae is commonly involved in both CAP and HAP in Asia, Europe and North America, with the highest association with CAP evident in Asia and developing countries (25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, microbiology and treatment implications in adult patients hospitalized with pneumonia in different regions of China: a retrospective study

Wen²,

Jia³

et al. 2017

J. Thorac. Dis.

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Background: Data describing epidemiology, clinical outcomes and treatment patterns, of hospitalised patients with pneumonia in China are limited. We aimed to describe such information among adult pneumonia patients in southern and northern China. Conclusions: Of the pathogens identified, Staphylococcus aureus infection (particularly the methicillinresistant S. aureus) was associated with poor clinical outcomes; however antibiotic resistance among S. aureus generally decreased during the study data collection periods. Also, disease severity was greater in Beijing as compared with Guangdong, and this may be associated with higher microbiological diagnosis rate and higher frequency of initial antibiotic modification among Beijing populations.

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Investigation of a Multiyear Multiple Critical Care Unit Outbreak Due to Relatively Drug-Sensitive Acinetobacter baumannii: Risk Factors and Attributable Mortality

Cited by 65 publications

References 47 publications

Risk Factors for Acquisition of Imipenem-Resistant Acinetobacter baumannii : a Case-Control Study

Risk Factors for Acquisition of Imipenem-Resistant Acinetobacter baumannii : a Case-Control Study

Acinetobacter septicus sp. nov. Association with a Nosocomial Outbreak of Bacteremia in a Neonatal Intensive Care Unit

Epidemiology, microbiology and treatment implications in adult patients hospitalized with pneumonia in different regions of China: a retrospective study

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