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Failure to Communicate: Transmission of Extensively Drug-Resistant blaOXA-237-Containing Acinetobacter baumannii—Multiple Facilities in Oregon, 2012–2014

Published online by Cambridge University Press:  05 September 2017

Genevieve L. Buser ,
P. Maureen Cassidy ,
Margaret C. Cunningham ,
Susan Rudin ,
Andrea M. Hujer ,
Robert Vega ,
Jon P. Furuno ,
Steven H. Marshall ,
Paul G. Higgins  and
Michael R. Jacobs
...Show all authors
Genevieve L. Buser*
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon
P. Maureen Cassidy
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon
Margaret C. Cunningham
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon
Susan Rudin
Affiliation:
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Andrea M. Hujer
Affiliation:
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Robert Vega
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon
Jon P. Furuno
Affiliation:
Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, Oregon
Steven H. Marshall
Affiliation:
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Paul G. Higgins
Affiliation:
Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany German Center for Infection Research (DZIF), Partner Site, Bonn-Cologne, Germany
Michael R. Jacobs
Affiliation:
Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
Meredith S. Wright
Affiliation:
J. Craig Venter Institute, La Jolla, California
Mark D. Adams
Affiliation:
J. Craig Venter Institute, La Jolla, California
Robert A. Bonomo
Affiliation:
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Departments of Pharmacology, Molecular Biology and Microbiology, Biochemistry, and Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio
Christopher D. Pfeiffer
Affiliation:
Department of Hospital & Specialty Medicine, VA Portland Health Care System, Portland, Oregon Division of Infectious Diseases, Department of Medicine, Oregon Health & Science University, Portland, Oregon
Zintars G. Beldavs
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon
*
Address correspondence to Genevieve L. Buser, MDCM, MSHP, Providence St Vincent Medical Center, 9427 SW Barnes Road, Suite 395, Portland, Oregon 97225 (Genevieve.buser@gmail.com).
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Abstract

OBJECTIVE

To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii.

DESIGN

Outbreak investigation.

SETTING AND PARTICIPANTS

Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals.

METHODS

A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed.

RESULTS

We identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n=8), or skilled nursing facility A (n=8), or both (n=1) prior to XDR A. baumannii isolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase gene blaOXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission.

CONCLUSIONS

Interfacility transmission of XDR A. baumannii carrying the rare blaOXA-237 was facilitated by transfer of affected patients without communication to receiving facilities.

Infect Control Hosp Epidemiol 2017;38:1335–1341

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 11 , November 2017 , pp. 1335 - 1341
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. These data were presented in part as “Investigation of First Carbapenem-Resistant Acinetobacter baumannii Outbreak in Oregon—Multi-Facility, 2012–2013” at the 2014 Council for State and Territorial Epidemiologists Annual Conference on June 23, 2014, in Nashville, Tennessee.

References

REFERENCES

1. Poirel, L, Nordmann, P. Carbapenem resistance in Acinetobacter baumannii: mechanism and epidemiology. Clin Microbiol Infect 2006;12:826–836.Google Scholar
2. Doi, Y, Husain, S, Potoski, BA, McCurry, KR, Paterson, DL. Extensively drug-resistant Acinetobacter baumannii . Emerg Infect Dis 2009;15:980–981.Google Scholar
3. Thom, KA, Maragakis, LL, Richards, K, et al. Assessing the burden of Acinetobacter baumannii in Maryland: a statewide cross-sectional period prevalence survey. Infect Control Hosp Epidemiol 2012;33:883–888.Google Scholar
4. Tuan Anh, N, Nga, TV, Tuan, HM, et al. The molecular epidemiology and antimicrobial resistance phenotypes of Acinetobacter baumannii isolated from patients in three hospitals in Southern Vietnam. J Med Microbiol 2017;66:46–53.CrossRefGoogle ScholarPubMed
5. Morgan, DJ, Liang, SY, Smith, CL, et al. Frequent multidrug-resistant Acinetobacter baumannii contamination of gloves, gowns, and hands of healthcare workers. Infect Control Hosp Epidemiol 2010;31:716–721.Google Scholar
6. Spellberg, B, Bonomo, RA. “Airborne assault”: a new dimension in Acinetobacter baumannii transmission. Crit Care Med 2013;41:1–3.Google Scholar
7. Lambert, T. Acinetobacter and other antibiotics. In Courvalin P, Leclercq R, Rice LB, eds Antibiogram. Portland, OR: ESKA Publishing, ASM Press; 2010:421–424.Google Scholar
8. Durante-Mangoni, E, Zarrilli, R. Global spread of drug-resistant Acinetobacter baumannii . Future Microbiol 2011;6:407–422.Google Scholar
9. Huang, SS, Avery, TR, Song, Y, et al. Quantifying interhospital patient sharing as a mechanism for infectious disease spread. Infect Control Hosp Epidemiol 2010;31:1160–1169.CrossRefGoogle ScholarPubMed
10. Mortensen, E, Trivedi, KK, Rosenberg, J, et al. Multidrug-resistant Acinetobacter baumannii infection, colonization, transmission related to a long-term care facility providing subacute care. Infect Control Hosp Epidemiol 2014;35:406–411.Google Scholar
11. Pfeiffer, CD, Cunningham, MC, Poissant, T, et al. Establishment of a statewide network for carbapenem-resistant Enterobacteriaceae prevention in a low-incidence region. Infect Control Hosp Epidemiol 2014;35:356–361.Google Scholar
12. Trick, We, Lin, MY, Cheng-Leidig, R, et al. Electronic public health registry of extensively drug-resistant organisms, Illinois, USA. Emerg Infect Dis 2015;21:1725–1732.CrossRefGoogle ScholarPubMed
13. Lin, MY, Trick, WE. Informatics in infection control. Infect Dis Clin N Am 2016;30:759–770.CrossRefGoogle ScholarPubMed
14. Dumyati, G, Stone, ND, Nace, DA, Crnich, CJ, Jump, RLP. Challenges and strategies for prevention of multidrug-resistant organism transmission in nursing homes. Curr Infect Dis Rep 2017;19:18.CrossRefGoogle ScholarPubMed
15. Magill, SS, Dumyati, G, Ray, SM, Fridkin, SK. Evaluating epidemiology and improving surveillance of infections associated with health care, United States. Emerg Infect Dis 2015;21:1537–1542.Google Scholar
16. Ajao, AO, Robinson, G, Lee, MS, et al. Comparison of culture media for detection of Acinetobacter baumannii in surveillance cultures of critically-ill patients. Eur J Clin Microbiol Infect Dis 2011;30:1425–1430.Google Scholar
17. Prabaker, K, Lin, MY, McNally, M, et al. Transfer from high-acuity long-term care facilities is associated with carriage of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae: a multihospital study. Infect Control Hosp Epidemiol 2012;33:1193–1198.CrossRefGoogle ScholarPubMed
18. Magiorakos, AP, Srinivasan, A, Carey, RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268–281.Google Scholar
19. Thom, KA, Howard, T, Sembajwe, S, et al. Comparison of swab and sponge methodologies for identification of Acinetobacter baumannii from the hospital environment. J Clin Microbiol 2012;50:2140–2141.Google Scholar
20. Performance standards for antimicrobial susceptibility testing. twenty-second informational supplement. Clin Lab Stnd Inst 2012;32(3):M100–S22.Google Scholar
21. Tenovar, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
22. Hiett, KL, Seal, BS. Use of repetitive element palindromic PCR (rep-PCR) for the epidemiologic discrimination of foodborne pathogens. Methods Mol Biol 2009;551:49–58.CrossRefGoogle ScholarPubMed
23. Hujer, AM, Higgins, PG, Rudin, S, et al. A nosocomial outbreak of extensively drug resistant (XDR) Acinetobacter baumannii isolates containing bla OXA-237 encoded on a plasmid. Antimicrob Agents Chemother. In press.Google Scholar
24. Guide to the Elimination of Multidrug-resistant Acinetobacter baumannii Transmission in Healthcare Settings, 2010. Association of Professionals in Infection Control website. http://www.apic.org/Resource_/EliminationGuideForm/b8b0b11f-1808-4615-890b-f652d116ba56/File/APIC-AB-Guide.pdf. Published 2010. Accessed April 7, 2017.Google Scholar
25. Communication During Patient Transfer of Multidrug Resistant Organisms, Oregon Administrative Rule 333-019-0052. Oregon Health Authority website. http://arcweb.sos.state.or.us/pages/rules/oars_300/oar_333/333_019.html. Published 2014. Accessed April 7, 2017.Google Scholar
26. Higgins, PG, Dammhayn, C, Hackel, M, Seifert, H. Global spread of carbapenem-resistant Acinetobacter baumannii . J Antimicrob Chemother 2010;65:233–238.Google Scholar
27. Higgins, PG, Perez-Llarena, FJ, Zander, E, Fernandez, A, Bou, G, Seifert, H. OXA-235. A novel class D β-lactamase involved in resistance to carbapenems in Acinetobacter baumannii . Antimicrob Agents Chemother 2013;57:2121–2126.Google Scholar
28. Evans, BA, Amyes, SGB. OXA β-lactamases. Clin Microbiol Rev 2014;27:241–263.Google Scholar
29. Lolans, K, Rice, TW, Munoz-Price, LS, Quinn, JP. Multicity outbreak of carbapenem-resistant Acinetobacter baumannii isolates producing the carbapenemase OXA-40. Antimicrob Agents Chemother 2006;50:2941–2945.CrossRefGoogle ScholarPubMed
30. Adams-Haduch, JM, Onuoha, EO, et al. Molecular epidemiology of carbapenem-nonsusceptible Acinetobacter baumannii in the United States. J Clin Microbiol 2011;49:3849–3854.Google Scholar
31. Won, SY, Munoz-Price, LS, Lolans, K, Hota, B, Weinstein, RA, Hayden, MK. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2011;53:532–540.Google Scholar
32. Halachev, MR, Chan, JZM, Constantinidou, CI, et al. Genomic epidemiology of a protracted hospital outbreak caused by multidrug-resistant Acinetobacter baumannii in Birmingham, England. Genome Med 2014;6:70–83.Google Scholar
33. Higgins, PG, Poirel, L, Lehmann, M, Nordmann, P, Seifert, H. OXA-143, a novel carbapenem-hydrolyzing class D β-lactamase in Acinetobacter baumannii . Antimicrob Agents Chemother 2009;53:5036–5038.CrossRefGoogle Scholar
34. Decker, BK, Perez, F, Hujer, AM, et al. Longitudinal analysis of the temporal evolution of Acinetobacter baumannii strains in Ohio, USA, by using rapid automated typing methods. PLoS ONE 2012;7:e33443.Google Scholar
35. Ou, H, Kuang, SN, He, X, et al. Complete genome sequence of hypervirulent and outbreak-associated Acinetobacter baumannii strain LAC-4: epidemiology, resistance genetic determinants and potential virulence factors. Scientific Reports 2015;5:8643.Google Scholar
36. Furuno, JP, Hebden, JN, Standiford, HC, et al. Prevalence of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii in a long-term acute care facility. Am J Infect Control 2008;36:468–471.Google Scholar