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Community-acquired in name only: A cluster of carbapenem-resistant Acinetobacter baumannii in a burn intensive care unit and beyond

Published online by Cambridge University Press:  28 February 2020

Erica S. Shenoy*
Affiliation:
Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts Department of Medicine, Harvard Medical School, Boston, Massachusetts
Virginia M. Pierce
Affiliation:
Division of Pathology, Massachusetts General Hospital, Boston, Massachusetts Pediatric Infectious Disease Unit, MassGeneral Hospital for Children, Boston, Massachusetts Department of Pathology, Harvard Medical School, Boston, Massachusetts
Mohamad R. A. Sater
Affiliation:
Day Zero Diagnostics, Boston, Massachusetts
Febriana K. Pangestu
Affiliation:
Day Zero Diagnostics, Boston, Massachusetts
Ian C. Herriott
Affiliation:
Day Zero Diagnostics, Boston, Massachusetts
Melis N. Anahtar
Affiliation:
Division of Pathology, Massachusetts General Hospital, Boston, Massachusetts Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Juliet T. Bramante
Affiliation:
Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Douglas S. Kwon
Affiliation:
Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts Department of Medicine, Harvard Medical School, Boston, Massachusetts Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Fred R. Hawkins Jr
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
Dolores Suslak
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
Lauren R. West
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
Miriam H. Huntley
Affiliation:
Day Zero Diagnostics, Boston, Massachusetts
David C. Hooper
Affiliation:
Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts Department of Medicine, Harvard Medical School, Boston, Massachusetts
*
Author for correspondence: Erica S. Shenoy, E-mail: eshenoy@mgh.harvard.edu

Abstract

Objective:

To describe an investigation into 5 clinical cases of carbapenem-resistant Acinetobacter baumannii (CRAB).

Design:

Epidemiological investigation supplemented by whole-genome sequencing (WGS) of clinical and environmental isolates.

Setting:

A tertiary-care academic health center in Boston, Massachusetts.

Patients or participants:

Individuals identified with CRAB clinical infections.

Methods:

A detailed review of patient demographic and clinical data was conducted. Clinical isolates underwent phenotypic antimicrobial susceptibility testing and WGS. Infection control practices were evaluated, and CRAB isolates obtained through environmental sampling were assessed by WGS. Genomic relatedness was measured by single-nucleotide polymorphism (SNP) analysis.

Results:

Four clinical cases spanning 4 months were linked to a single index case; isolates differed by 1–7 SNPs and belonged to a single cluster. The index patient and 3 case patients were admitted to the same room prior to their development of CRAB infection, and 2 case patients were admitted to the same room within 48 hours of admission. A fourth case patient was admitted to a different unit. Environmental sampling identified highly contaminated areas, and WGS of 5 environmental isolates revealed that they were highly related to the clinical cluster.

Conclusions:

We report a cluster of highly resistant Acinetobacter baumannii that occurred in a burn ICU over 5 months and then spread to a separate ICU. Two case patients developed infections classified as community acquired under standard epidemiological definitions, but WGS revealed clonality, highlighting the risk of burn patients for early-onset nosocomial infections. An extensive investigation identified the role of environmental reservoirs.

Type
Original Article
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

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