Long-term control of hospital-wide, endemic multidrug-resistant Acinetobacter baumannii through a comprehensive “bundle” approach

Rodríguez-Baño, Jesús; García, Lola; Ramírez, Encarnación; Martínez-Martínez, Luis; Muniain, Miguel A.; Fernández-Cuenca, Felipe; Beltrán, Margarita; Gálvez, Juan Francisco Pérez; Rodrı́guez, José Manuel; Velasco, C.; Morillo, Concepción; Pérez, Federico; Endimiani, Andrea; Bonomo, Robert A.; Pascual, Álvaro

doi:10.1016/j.ajic.2009.01.008

Cited by 85 publications

(66 citation statements)

References 35 publications

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“…The real-time assay was negative when genomic DNA from clinical isolates of Pseudomonas aeruginosa, Klebsiella pneumoniae, Moraxella catarrhalis, and Escherichia coli was used in the assay. Taken together, these results indicate that the ompA real-time assay is sensitive and specific for detecting and quantifying A. baumannii genomic DNA.Results from environmental samples in the ICUs demonstrated that A. baumannii was identified on 39% of surfaces using bacterial culture (Table 1), a prevalence similar to those of previous reports describing the presence of A. baumannii on environmental surfaces in intensive care settings in which this species is endemic (1,8). Duplicate samples tested using real-time PCR showed the presence of A. baumannii on 77% of surfaces, a significantly higher level than the results obtained with bacterial culture (P Ͻ 0.0001 by chi-squared test).…”

supporting

confidence: 76%

“…In this context, patients are exposed to A. baumannii via contact with contaminated hospital equipment or by contact with hospital personnel carrying the bacteria. A number of studies have demonstrated widespread contamination with A. baumannii on hospital environmental surfaces, most notably in intensive care units (ICUs) (1,4,8,9).Environmental surveillance protocols have been employed for the identification of hospital equipment colonized by A. baumannii so that appropriate decontamination procedures can be carried out (1,4,8,9). Since these surveillance methods employ conventional bacterial culture to determine the presence of A. baumannii, definitive species identification can require between 24 and 48 h. Nucleic acid-based tests, such as real-time PCR, have been employed for the identification of numerous bacterial pathogens (2); however, to our knowledge this technique has not been applied to identifying contaminated hospital equipment.…”

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confidence: 99%

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Quantitative Real-Time PCR for Detection of Acinetobacter baumannii Colonization in the Hospital Environment

et al. 2012

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A real-time PCR assay was developed for detecting the presence of Acinetobacter baumannii on hospital equipment and compared to conventional bacterial culture using 100 hospital environmental samples. The real-time PCR detected contaminated surfaces in 4 h with high sensitivity (100%) compared to conventional culture. Thirty-eight percent of samples were positive by real-time PCR and negative by bacterial culture (false positives), possibly indicating the widespread presence of bacterial DNA that is not associated with viable bacteria. N osocomial infections caused by drug-resistant bacteria represent an important clinical challenge. Acinetobacter baumannii has become one of the most problematic causative agents of nosocomial infections due to its remarkable ability to survive on hospital surfaces and acquire antibiotic resistance, resulting in the global emergence of multidrug-resistant strains with resistance to multiple antibiotic classes (5). A. baumannii has been especially problematic in critically ill patients in the intensive care setting, as it is an important cause of ventilator-associated pneumonia and bacteremia. In this context, patients are exposed to A. baumannii via contact with contaminated hospital equipment or by contact with hospital personnel carrying the bacteria. A number of studies have demonstrated widespread contamination with A. baumannii on hospital environmental surfaces, most notably in intensive care units (ICUs) (1,4,8,9).Environmental surveillance protocols have been employed for the identification of hospital equipment colonized by A. baumannii so that appropriate decontamination procedures can be carried out (1,4,8,9). Since these surveillance methods employ conventional bacterial culture to determine the presence of A. baumannii, definitive species identification can require between 24 and 48 h. Nucleic acid-based tests, such as real-time PCR, have been employed for the identification of numerous bacterial pathogens (2); however, to our knowledge this technique has not been applied to identifying contaminated hospital equipment. The objective of the present study was to develop a real-time PCR for identifying hospital surfaces colonized by A. baumannii.A real-time PCR assay was developed using TaqMan chemistry for the amplification of nucleotides 774 to 859 of the outer membrane protein A gene (ompA; accession number AY485227). The ompA gene was chosen because it is present in all sequenced genomes of A. baumannii available in the public domain (as of March 2010), and the sequences chosen for the primers and probe correspond to regions highly conserved between published A. baumannii ompA sequences (100% sequence identity). The primers OmpA Forward (5=-TCTTGGTGGTCACTTGAAGC-3=) and Ompa Reverse (5=-ACTCTTGTGGTTGTGGAGCA-3=) and the probe (5=-AAGTTGCTCCAGTTGAACCAACTCCA-3=), 5= labeled with 6-carboxyfluorescein and the 3= labeled with 6-carboxytetramethylrhodamine, were used. A quantification standard, pGEM-ompA, was constructed by inserting the ompA gene from the ATCC 19606 strain...

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confidence: 99%

Quantitative Real-Time PCR for Detection of Acinetobacter baumannii Colonization in the Hospital Environment

et al. 2012

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“…7 Other nosocomial infections, such as Acinetobacter baumanii, present rates of infection more similar to those found for rotavirus in this study (0.82 cases per 100 admissions). 12 When comparing local studies performed in other WHO European Region countries, significant variation in nosocomial rotavirus incidence rate can be found, from 1% of all admissions in Israel or 1.9% in Italy to 13.9% in France. 6,11,13 In other countries, published rotavirus incidence rates range from 0.03 per 100 admissions in Australia to 2 per 100 admissions in Brazil.…”

Section: Discussionmentioning

confidence: 99%

Hospital-acquired rotavirus infections in Spain over a ten-year period (1998-2007)

Gil-Prieto¹,

M²,

Al³

et al. 2009

Human Vaccines

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IntroductionAcute gastroenteritis poses an important health problem in developing countries and a considerable economic burden in developed countries, taking into account not only direct costs but also indirect costs, such us days of work lost by parents. 1,2 Rotavirus is regarded as the most frequent cause of acute gastroenteritis, with 3.6 million cases per year in children up to five years of age in Europe, 3,4 and it imposes a median hospitalization cost of 1,417 Euros among EU-25 Member States.Rotavirus can survive for weeks in water and on different surfaces. Thus, it is easily transmitted through contaminated surfaces, particularly in kindergartens and pediatric units in hospitals. Hygienic preventive measures are not effective in stopping transmission, hence the high morbidity in developed countries.Real incidence of rotavirus infection is underestimated because there is not a specific epidemiological surveillance system. It is estimated that a significant percentage (20 to 60%) of hospital admissions due to acute diarrhea in children are caused by rotavirus, most of these in children younger than six months. Although rotavirusrelated mortality in developed countries is low, the morbidity and associated consumption of health care resources are considered to be high. 5Gastrointestinal infections, especially those caused by rotavirus, are considered among the most frequent cause of nosocomial infection in pediatric units. In contrast to community-acquired rotavirus, nosocomial infections mainly affect breast-fed babies under six months of age.5 Symptoms appear two to six days after hospitalization. A high percentage of non-symptomatic carriers contribute to spread of the infection. The risk of nosocomial infection is associated with lengthy hospitalizations, low birth weight, presence of chronic pathology, immunocompromise and malnutrition. [5][6][7] This study was performed to assess the burden of nosocomial rotavirus infection in Spain during a 10-year period. ResultsA total of 10,990 cases of rotavirus disease (ICD 9 CM codes 008.61; secondary diagnosis position) in hospitalized children five years of age and younger were reported during the 10-year Hospital-acquired rotavirus infections in spain over a ten-year period (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007) Ruth Gil-prieto, Background and objectives: To analyze the epidemiology and burden of rotavirus infections amongst hospitalized children up to 5 years of age in spain over a 10-year period (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007).Results: During the study period (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007), a total of 10,990 cases of rotavirus disease mentioned as a secondary diagnosis were recorded (annual incidence of 59.02 cases per 100,000 people and 0.45 cases per 100 admissions). The average patient age was 9.8 months (sD 9.3), with 71% of the patients younger than 12 months of age. The mortality rate for children hospitalized for other primary causes, with rotavirus gastroenteritis as a...

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“…Samples were collected from patient beds, bedside tables, alcohol-based hand rub dispensers, IV poles, bedside chairs, equipment carts, infusion pumps, patient records, doorknobs, keyboards, storage cabinets, nurses' stations, sinks, light switches, heating vents, ambu-bags, dialysis units, telephones, and ultrasound equipment. After sample collection, swabs were placed in 1 ml of Luria-Bertani broth and incubated at 37°C for 24 h with shaking at 220 rpm, as incubation of samples in nonselective media has been shown to be effective for isolation of A. baumannii (1,6). One hundred microliters of the enrichment culture was spread on LAM plates (Hardy Diagnostics, CA) and incubated for 16 h at 37°C.…”

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confidence: 99%

“…Environmental surveillance of hospital surfaces is useful in determining if equipment is colonized by A. baumannii and identifying the sources of hospital outbreaks (3,5,6). Leeds Acinetobacter medium (LAM) is a differential medium developed to selectively support the growth of Acinetobacter species (4).…”

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confidence: 99%

Positive Predictive Value of Leeds Acinetobacter Medium for Environmental Surveillance of Acinetobacter baumannii

McConnell¹,

Pérez‐Romero²,

Lepe³

et al. 2011

J Clin Microbiol

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Long-term control of hospital-wide, endemic multidrug-resistant Acinetobacter baumannii through a comprehensive “bundle” approach

Cited by 85 publications

References 35 publications

Quantitative Real-Time PCR for Detection of Acinetobacter baumannii Colonization in the Hospital Environment

Quantitative Real-Time PCR for Detection of Acinetobacter baumannii Colonization in the Hospital Environment

Hospital-acquired rotavirus infections in Spain over a ten-year period (1998-2007)

Positive Predictive Value of Leeds Acinetobacter Medium for Environmental Surveillance of Acinetobacter baumannii

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