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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)...

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 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.

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

Copyright

Corresponding author

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).

Footnotes

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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.

Footnotes

References

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