Management of a Major Carbapenem-Resistant Acinetobacter baumannii Outbreak in a French Intensive Care Unit While Maintaining Its Capacity Unaltered

Abstract

We describe bundle measures implemented to overcome a protracted carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak in an 18-bed trauma Intensive Care Unit (ICU) at Strasbourg University Hospital, a tertiary referral center in France. Outbreak cases were defined by a positive CRAB sample with OXA-23 profile during or after ICU say. To sustain the capacity of the busy trauma ICU, infection control bundles were purposely selected to control the outbreak without closing the ICU. During the outbreak, from May 2015 to January 2019, 141 patients were contaminated by CRAB, including 91 colonized and 50 infected patients. The conventional infection and prevention control (IPC) measures implemented included weekly active surveillance of patients’ samples, enhancement of environmental cleaning, interventions to improve hand hygiene compliance and antibiotic stewardship with audits. Supplemental measures were needed, including environmental samplings, health care workers’ (HCWs) hand sampling, chlorhexidine body-washing, relocation of the service to implement Airborne Disinfection System (ADS), replication of crisis cells, replacement of big environmental elements and improvement of HCW organization at the patient’s bedside. The final measure was the cohorting of both CRAB patients and HCW caring for them. Only the simultaneous implementation of aggressive and complementary measures made it possible to overcome this long-lasting CRAB epidemic. Facing many CRAB cases during a rapidly spreading outbreak, combining simultaneous aggressive and complementary measures (including strict patients and HCW cohorting), was the only way to curb the epidemic while maintaining ICU capacity.

Colistin Resistance in Acinetobacter baumannii: Molecular Mechanisms and Epidemiology

“…A. baumannii is recognized as a clinically significant pathogen causing a wide spectrum of nosocomial infections, especially in vulnerable patient groups [ 12 ]. These groups include intensive care unit (ICU) patients, patients with prolonged hospitalization in long-term care facilities, patients undergoing surgeries, central vascular catheterization, tracheostomy, and enteral hemorrhage, and low birth weight neonates [ 13 , 14 , 15 , 16 , 17 ]. The literature data on nosocomial A. baumannii infections are mainly based on reports of outbreaks [ 18 ].…”

Molecular Epidemiological Investigation and Management of Outbreak Caused by Carbapenem-Resistant Acinetobacter baumannii in a Neonatal Intensive Care Unit

“…Carbapenem-resistant Acinetobacter baumannii (CRAB) is regarded as one of the main culprits for nosocomial infections and outbreaks [1][2][3]. Its recent emergence and increasing prevalence in intensive care units (ICUs) has gained notoriety in clinical settings as it poses Microorganisms 2023, 11, 1073 2 of 11 serious threats to debilitated patients, causing infections that are normally associated with significant morbidity and mortality [4].…”

Control of Healthcare-Associated Carbapenem-Resistant Acinetobacter baumannii by Enhancement of Infection Control Measures

“…Mathematical models also suggest the existence of thresholds of antimicrobial consumption beyond which resistance would be triggered [ 12 ]. The antimicrobial stewardship program was associated with a significant impact in reducing the incidence of CRAB in the hospital [ 13 ] and contributed to the control of outbreak [ 14 ].…”