Skip to main content Accessibility help
×
Home

Delayed Detection of an Increase in Resistant Acinetobacter at a Detroit Hospital

  • David R. Johnson (a1) (a2), Melinda A. Love-Dixon (a3), William J. Brown (a4) (a5), Donald P. Levine (a5), Frances P. Downes (a2) and William N. Hall (a2)...

Abstract

Objective:

To study an increase of antimicrobial-resistant Acinetobacter baumannii and to assess reasons for the delayed detection of this increase.

Design:

Review of medical, laboratory, and infection control records. Plasmid profile analysis of available A baumannii isolates.

Setting:

A 340-bed trauma and intensive care hospital in Detroit, Michigan.

Results:

The number of hospitalized patients with resistant A baumannii increased during late 1989 and early 1990: 4 in September, 10 in October, 12 in November, 18 in December, and 23 in January (chi square for trend = 14.6, p= .0001). Forty-four (66%) of the 67 patients culture-positive for resistant A baumannii had respiratory tract colonization or infection. Of 11 resistant isolates, 6 had a similar plasmid profile and 5 had no plasmids. Under the hospital's targeted surveillance system, only positive cultures from blood or wounds were investigated; this largely respiratory increase of resistant A baumannii went unrecognized until January 1990.

Conclusions:

Antimicrobial resistance in A baumannii is an important concern. Such resistance is not necessarily plasmid mediated. Tar geted surveillance for this and other agents of nosocomial infection should be used with caution, particularly in hospitals with many debilitated patients.

Copyright

Corresponding author

Michigan Dept. of Public Health, Bureau of Infectious Disease Control, 3500 North Logan, PO Box 30035, Lansing, MI 48909

References

Hide All
1.Baumann, P. Isolation of Acinetobacter from soil and water. J Bacteriol. 1968;96:3942.
2.Taplin, D, Rebell, G, Zaias, N. The human skin as a source of Mima-Herellea infections. JAMA. 1963;186:952955.
3.Rosenthal, S, Tager, IB. Prevalence of gram-negative rods in the normal pharyngeal flora. Ann Intern Med. 1975;83:355357.
4.Bouvet, PJM, Grimont, PAD. Taxonomy of the genus Acinetobacter with the recognition of Acinetobacter baumannii sp nov, Acinetobacteo haemolytics sp nov, Acinetobacter johnsonii sp nov, and Acinetobacter junii sp nov and emended descriptions of Acinetobacter calcoaceticus and Acinetobacter Iwoffii. International Journal of Systematic Bacteriology. 1986;36:228240.
5.Beck-Sague, CM, Jarvis, WR, Culver, DH. Secular trends in nosocomial Acinetobacter calcoaceticus incidence and antimicrobial resistance. Presented at the Twenty-eighth Interscience Conference on Antimicrobial Agents and Chemotherapy; 1988; Abstract # 1081.
6.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128140.
7.Mantel, N. Chi-square tests with one degree of freedom; extensions of the Mantel-Haenszel procedure. Journal of the American Statistical Association. 1963;58:690700.
8.Greenland, S, Robins, JM. Estimation of a common effect parameter from sparse follow-up data. Biometrics. 1985;41:5568.
9.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing; Second Informational Supplement. Document M100-S2. Villanova, Pa: National Committee for Clinical Laboratory Standards; 1987.
10.Rubin, SJ, Granato, PA, Wasilauskas, BL. Glucose-nonfermenting gram-negative bacteria. In: Lennette, EH, Balows, A, Hausler, WJ Jr, Dhadomy, JH, eds. Manual of Clinical Microbiology. 4th ed. Washington, DC: American Society for Microbiology; 1985:330349.
11.Birnboim, HC, Doly, J. A rapid alkaline extraction procedure for screening recombinant DNA. Nucleic Acids Res. 1979;7:15131523.
12.Smith, PW, Massanari, RM. Room humidifiers as the source of Acinetobacter infections. JAMA. 1977;237:795797.
13.Castle, M, Tenney, JH, Weinstein, MP, Eickhoff, TC. Outbreak of a multiply resistant Acinetobacter in a surgical intensive care unit: epidemiology and control. Heart Lung. 1978;7:641644.
14.Chuna, BA, Klimek, JJ, Gracewski, J, McLaughlin, JC, Quintiliani, R. A common source outbreak of Acinetobacter pulmonary infections traced to Wright respirometers. Postgrad Med J. 1980;56:169172.
15.Carlquist, JF, Conti, M, Burke, JP. Progressive resistance in a single strain of Acinetobacter calcoaceticus recovered during a nosocomial outbreak. Am J Infect Control. 1982;10:4348.
16.Gervich, DH, Grout, CS. An outbreak of nosocomial Acinetobacter infections from humidifiers. Am J Infect Control. 1985;13:210215.
17.Allen, KD, Green, HT. Hospital outbreak of multi-resistant Acinetobacter anitratus: an airborne mode of spread? J Hosp Infect. 1987;9:110119.
18.Peacock, JE, Sorrell, L, Sottile, FD, Price, LE, Rutala, WA. Nosocomial respiratory tract colonization and infection with aminogly-coside-resistant Acinetobacter calcoaceticus var anitratus: epidemiologic characteristics and clinical significance. Infect Control Hosp Epidemiol. 1988;9:302308.
19.Hartstein, AI, Rashad, AL, Liebler, JM, et al. Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contaminated, reusable ventilator circuits and resuscitation bags. Am J Med. 1988;85:624631.
20.Crombach, WHJ, Dijkshoorn, L, van Noort-Klaassen, M, Niessen, J, van Knippenberg-Gordebeke, G. Control of an epidemic spread of a multi-resistent strain of Acinetobacter calcoaceticus in a hospital. Intensive Care Med. 1989;15:166170.
21.Cefai, C, Richards, J, Gould, FK, McPeake, l? An outbreak of Acinetobacter respiratory tract infection resultine from incomplete disinfection of ventilatory equipment. 7 Hosp Infect. 1990;15:177182.
22.Contant, J, Kemeny, E, Oxley, C, Perry, E, Garber, G. Investigation of an outbreak of Acinetobacter calcoaceticus var anitratus infections in an adult intensive care unit. Am J Infect Control. 1990;18:288291.
23.Beck-Sague, CM, Jarvis, WR, Brook, JH, et al. Epidemic bacteremia due to Acinetobacter baumannii in five intensive care units. Am J Epidemiol. 1990;132:723733.
24.Hartstein, AI, Morthland, VH, Rourke, JW, et al. Plasmid DNA fingerprinting of Acinetobacter calcoaceticus subspecies anitratus from intubated and mechanically ventilated patients. Infect Control Hosp Epidemiol 1990;11:531538.

Related content

Powered by UNSILO

Delayed Detection of an Increase in Resistant Acinetobacter at a Detroit Hospital

  • David R. Johnson (a1) (a2), Melinda A. Love-Dixon (a3), William J. Brown (a4) (a5), Donald P. Levine (a5), Frances P. Downes (a2) and William N. Hall (a2)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.