Rapid control of a hospital‐wide outbreak caused by extensively drug‐resistant OXA‐72‐producing Acinetobacter baumannii

The Kaohsiung Journal of Medical Sciences - Tập 27 - Trang 207-214 - 2011
Wei-Ru Lin1,2, Po-Liang Lu1,3,4, Leung-Kei Siu5, Tun-Chieh Chen1,4, Chun-Yu Lin1,4, Ching-Tzu Hung2, Yen-Hsu Chen1,2,3,4, 林蔚如1,2, 盧柏樑1,3,4, 蕭樑基5, 陳惇杰1,4, 林俊祐1,4, 洪靖慈2, 陳彥旭1,2,3,4
1Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
2Department of Infection Control, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
3Department of Clinical Laboratory, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
4Graduate Institute of Medicine, Tropical Medicine Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
5Division of Clinical Research, National Health Research Institutes, Taipei, Taiwan

Tóm tắt

Abstract

Extensively drug‐resistant Acinetobacter baumannii (XDRAb) emerges as an important pathogen of health care–associated infections and outbreaks worldwide. During January and February 2006, there was a hospital‐wide outbreak of XDRAb at a medical center in Taiwan. Without limiting the usage of carbapenems or the closure of any ward, this outbreak was effectively controlled. We investigated the molecular epidemiology and reported the infection control experiences. XDRAb is defined as A baumannii that is resistant to multiple antibiotics but susceptible to tigecycline and polymyxin B. During the outbreak, the clinical and environmental XDRAb isolates were collected and studied by antimicrobial susceptibility testing, pulsed‐field gel electrophoresis, and polymerase chain reaction for Verona integron‐encoded metallo‐beta‐lactamases, imipenemases, and oxacillinases (OXA). Our measures to control the outbreak included private room isolation of patients until there were three successive negative cultures, reinforcement of contact precautions, daily environmental cleansing with room‐dedicated cleaning tools and sodium hypochlorite, and careful auditing of adherence. During the outbreak, 32 clinical XDRAb isolates came from 13 patients who were hospitalized in four intensive care units and three wards. Most (7 of 13, 53.8%) cases were associated with a surgical intensive care unit. The results from pulsed‐field gel electrophoresis study indicated that all isolates were of one genotype. All 32 isolates harbored ISAba1‐blaOxA‐51‐like and blaOxA‐72 genes. After this outbreak till August 2010, further incidences of XDRAb were sporadic cases of XDRAb with different clones and did not reach the level of outbreak. To our knowledge, this is the first reported hospital‐wide outbreak caused by OXA‐72 carbapenemase–producing A baumannii in the Asia‐Pacific region, with successful and sustained control. Although the source or vehicle of the outbreak was not identified, our results suggest that a hospital‐wide outbreak can be successfully managed with strict infection control measures, and that the limitation of the use of carbapenems and closure of wards may not be necessary.


Tài liệu tham khảo

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The Kaohsiung Journal of Medical Sciences

Tập 27

207-214

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