Skip to main content Accessibility help

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

  • Genevieve L. Buser (a1), P. Maureen Cassidy (a1), Margaret C. Cunningham (a1), Susan Rudin (a2) (a3), Andrea M. Hujer (a2) (a3), Robert Vega (a1), Jon P. Furuno (a4), Steven H. Marshall (a2), Paul G. Higgins (a5) (a6), Michael R. Jacobs (a7), Meredith S. Wright (a8), Mark D. Adams (a8), Robert A. Bonomo (a2) (a3) (a9), Christopher D. Pfeiffer (a10) (a11) and Zintars G. Beldavs (a1)...



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


Outbreak investigation.


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


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.


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 bla OXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission.


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


Corresponding author

Address correspondence to Genevieve L. Buser, MDCM, MSHP, Providence St Vincent Medical Center, 9427 SW Barnes Road, Suite 395, Portland, Oregon 97225 (


Hide All

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.



Hide All
1. Poirel, L, Nordmann, P. Carbapenem resistance in Acinetobacter baumannii: mechanism and epidemiology. Clin Microbiol Infect 2006;12:826836.
2. Doi, Y, Husain, S, Potoski, BA, McCurry, KR, Paterson, DL. Extensively drug-resistant Acinetobacter baumannii . Emerg Infect Dis 2009;15:980981.
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;33:883888.
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;66:4653.
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;31:716721.
6. Spellberg, B, Bonomo, RA. “Airborne assault”: a new dimension in Acinetobacter baumannii transmission. Crit Care Med 2013;41:13.
7. Lambert, T. Acinetobacter and other antibiotics. In Courvalin P, Leclercq R, Rice LB, eds Antibiogram. Portland, OR: ESKA Publishing, ASM Press; 2010:421424.
8. Durante-Mangoni, E, Zarrilli, R. Global spread of drug-resistant Acinetobacter baumannii . Future Microbiol 2011;6:407422.
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;31:11601169.
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;35:406411.
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;35:356361.
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;21:17251732.
13. Lin, MY, Trick, WE. Informatics in infection control. Infect Dis Clin N Am 2016;30:759770.
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.
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;21:15371542.
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;30:14251430.
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;33:11931198.
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;18:268281.
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;50:21402141.
20. Performance standards for antimicrobial susceptibility testing. twenty-second informational supplement. Clin Lab Stnd Inst 2012;32(3):M100S22.
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;33:22332239.
22. Hiett, KL, Seal, BS. Use of repetitive element palindromic PCR (rep-PCR) for the epidemiologic discrimination of foodborne pathogens. Methods Mol Biol 2009;551:4958.
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.
24. Guide to the Elimination of Multidrug-resistant Acinetobacter baumannii Transmission in Healthcare Settings, 2010. Association of Professionals in Infection Control website. Published 2010. Accessed April 7, 2017.
25. Communication During Patient Transfer of Multidrug Resistant Organisms, Oregon Administrative Rule 333-019-0052. Oregon Health Authority website. Published 2014. Accessed April 7, 2017.
26. Higgins, PG, Dammhayn, C, Hackel, M, Seifert, H. Global spread of carbapenem-resistant Acinetobacter baumannii . J Antimicrob Chemother 2010;65:233238.
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;57:21212126.
28. Evans, BA, Amyes, SGB. OXA β-lactamases. Clin Microbiol Rev 2014;27:241263.
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;50:29412945.
30. Adams-Haduch, JM, Onuoha, EO, et al. Molecular epidemiology of carbapenem-nonsusceptible Acinetobacter baumannii in the United States. J Clin Microbiol 2011;49:38493854.
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;53:532540.
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;6:7083.
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;53:50365038.
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.
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.
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;36:468471.


Altmetric attention score

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