Hostname: page-component-7479d7b7d-767nl Total loading time: 0 Render date: 2024-07-11T01:14:00.390Z Has data issue: false hasContentIssue false

Surveillance cultures following a regional outbreak of carbapenem-resistant Acinetobacter baumannii

Published online by Cambridge University Press:  14 May 2021

Frida Rivera
Affiliation:
Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Allison Reeme
Affiliation:
Department of Infection Prevention and Control, Froedtert Hospital, Milwaukee, Wisconsin
Mary Beth Graham
Affiliation:
Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Blake W. Buchan
Affiliation:
Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
Nathan A. Ledeboer
Affiliation:
Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
Ann M. Valley
Affiliation:
Wisconsin State Laboratory of Hygiene, Madison, Wisconsin
L. Silvia Munoz-Price*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
*
Author for correspondence: L. Silvia Munoz-Price, E-mail: smunozprice@mcw.edu

Abstract

Objectives:

The primary aim of this study was to assess the epidemiology of carbapenem-resistant Acinetobacter baumannii (CRAB) for 9 months following a regional outbreak with this organism. We also aimed to determine the differential positivity rate from different body sites and characterize the longitudinal changes of surveillance test results among CRAB patients.

Design:

Observational study.

Setting:

A 607-bed tertiary-care teaching hospital in Milwaukee, Wisconsin.

Patients:

Any patient admitted from postacute care facilities and any patient housed in the same inpatient unit as a positive CRAB patient.

Methods:

Participants underwent CRAB surveillance cultures from tracheostomy secretions, skin, and stool from December 5, 2018, to September 6, 2019. Cultures were performed using a validated, qualitative culture method, and final bacterial identification was performed using mass spectrometry.

Results:

In total, 682 patients were tested for CRAB, of whom 16 (2.3%) were positive. Of the 16 CRAB-positive patients, 14 (87.5%) were residents from postacute care facilities and 11 (68.8%) were African American. Among positive patients, the positivity rates by body site were 38% (6 of 16) for tracheal aspirations, 56% (9 of 16) for skin, and 82% (13 of 16) for stool.

Conclusions:

Residents from postacute care facilities were more frequently colonized by CRAB than patients admitted from home. Stool had the highest yield for identification of CRAB.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Antibiotic resistance threats in the United States, 2019. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf. Published 2019. Accessed December 2, 2020.Google Scholar
Consales, G, Gramigni, E, Zamidei, L, Bettocchi, D, De Gaudio, AR. A multidrug-resistant Acinetobacter baumannii outbreak in intensive care unit: antimicrobial and organizational strategies. J Crit Care 2011;26:453459.CrossRefGoogle ScholarPubMed
Makke, G, Bitar, I, Salloum, T, et al. Whole-genome-sequence–based characterization of extensively drug-resistant Acinetobacter baumannii hospital outbreak. mSphere 2020;5(1):e0093419.CrossRefGoogle ScholarPubMed
Cornejo-Juárez, P, Cevallos, MA, Castro-Jaimes, S, et al. High mortality in an outbreak of multidrug-resistant Acinetobacter baumannii infection introduced to an oncological hospital by a patient transferred from a general hospital. PLoS One 2020;15(7):e0234684.CrossRefGoogle Scholar
Young, LS, Sabel, AL, Price, CS. Epidemiologic, clinical, and economic evaluation of an outbreak of clonal multidrug-resistant Acinetobacter baumannii infection in a surgical intensive care unit. Infect Control Hosp Epidemiol 2007;28:12471254.CrossRefGoogle Scholar
Sengstock, DM, Thyagarajan, R, Apalara, J, Mira, A, Chopra, T, Kaye, KS. Multidrug-resistant Acinetobacter baumannii: an emerging pathogen among older adults in community hospitals and nursing homes. Clin Infect Dis 2010;50:16111616.CrossRefGoogle ScholarPubMed
Lim, CJ, Cheng, AC, Kennon, J, et al. Prevalence of multidrug-resistant organisms and risk factors for carriage in long-term care facilities: a nested case-control study. J Antimicrob Chemother 2014;69:19721980.CrossRefGoogle ScholarPubMed
Mortensen, E, Trivedi, KK, Rosenberg, J, et al. Multidrug-resistant Acinetobacter baumannii infection, colonization, and transmission related to a long-term care facility providing subacute care. Infect Control Hosp Epidemiol 2014;35:406411.CrossRefGoogle ScholarPubMed
Mody, L, Gibson, KE, Horcher, A, et al. Prevalence of and risk factors for multidrug-resistant Acinetobacter baumannii colonization among high-risk nursing home residents. Infect Control Hosp Epidemiol 2015;36:11551162.CrossRefGoogle ScholarPubMed
Wybo, I, Blommaert, L, De Beer, T, et al. Outbreak of multidrug-resistant Acinetobacter baumannii in a Belgian university hospital after transfer of patients from Greece. J Hosp Infect 2007;67:374380.CrossRefGoogle Scholar
Harris, AD, Johnson, JK, Pineles, L, O’Hara, LM, Bonomo, RA, Thom, KA. Patient-to-patient transmission of Acinetobacter baumannii gastrointestinal colonization in the intensive care unit. Antimicrob Agents Chemother 2019;63(8):e0039219.CrossRefGoogle ScholarPubMed
Martins, N, Martins, IS, de Freitas, WV, et al. Imported and intensive care unit-born Acinetobacter baumannii clonal complexes: one-year prospective cohort study in intensive care patients. Microb Drug Resist 2013;19:216223.CrossRefGoogle ScholarPubMed
Chia, PY, Sengupta, S, Kukreja, A, Ponnampalavanar, SL, Ng, OT, Marimuthu, K. The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms. Antimicrob Resist Infect Control 2020;9:29.CrossRefGoogle ScholarPubMed
Ng, DHL, Marimuthu, K, Lee, JJ, et al. Environmental colonization and onward clonal transmission of carbapenem-resistant Acinetobacter baumannii (CRAB) in a medical intensive care unit: the case for environmental hygiene. Antimicrob Resist Infect Control 2018;7:51.CrossRefGoogle Scholar
Munoz-Price, LS, Quinn, JP. Deconstructing the infection control bundles for the containment of carbapenem-resistant Enterobacteriaceae . Curr Opin Infect Dis 2013;26:378387.CrossRefGoogle ScholarPubMed
Rodríguez-Baño, J, García, L, Ramírez, E, et al. Long-term control of hospital-wide, endemic multidrug-resistant Acinetobacter baumannii through a comprehensive “bundle” approach. Am J Infect Control 2009;37:715722.CrossRefGoogle ScholarPubMed
Cheon, S, Kim, MJ, Yun, SJ, Moon, JY, Kim, YS. Controlling endemic multidrug-resistant Acinetobacter baumannii in intensive care units using antimicrobial stewardship and infection control. Korean J Intern Med 2016;31:367374.CrossRefGoogle ScholarPubMed
Apisarnthanarak, A, Pinitchai, U, Thongphubeth, K, et al. A multifaceted intervention to reduce pandrug-resistant Acinetobacter baumannii colonization and infection in 3 intensive care units in a Thai tertiary-care center: a 3-year study. Clin Infect Dis 2008;47:760767.CrossRefGoogle Scholar
Munoz-Price, LS, Carling, P, Cleary, T, et al. Control of a two-decade endemic situation with carbapenem-resistant Acinetobacter baumannii: electronic dissemination of a bundle of interventions. Am J Infect Control 2014;42:466471.CrossRefGoogle ScholarPubMed
Liu, L, Liu, B, Li, W. Successful incidences of controlling multidrug-resistant, extensively drug-resistant, and nosocomial infection Acinetobacter baumannii using antibiotic stewardship, infection control programs, and environmental cleaning at a Chinese university hospital. Infect Drug Resist 2020;13:25572570.CrossRefGoogle Scholar
Enfield, KB, Huq, NN, Gosseling, MF, et al. Control of simultaneous outbreaks of carbapenemase-producing Enterobacteriaceae and extensively drug-resistant Acinetobacter baumannii infection in an intensive care unit using interventions promoted in the Centers for Disease Control and Prevention 2012 carbapenemase-resistant Enterobacteriaceae Toolkit. Infect Control Hosp Epidemiol 2014;35:810817.CrossRefGoogle Scholar
Florek, K, Wagner, S, Lasure, M, et al. Carbapenem-resistant Acinetobacter baumannii harboring a plasmid carrying blaOXA-72 in an outbreak involving an intensive care unit and long-term care facilities in Wisconsin. In: ASM Microbe 2019 (American Society for Microbiology); June 20–24, 2019; San Francisco, CA. Poster presentation AAR-630.Google Scholar
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.Google ScholarPubMed
Nutman, A, Lerner, A, Fallach, N, Schwartz, D, Carmeli, Y. Likelihood of persistent carriage of carbapenem-resistant Acinetobacter baumannii on readmission in previously identified carriers. Infect Control Hosp Epidemiol 2019;40:11881190.CrossRefGoogle ScholarPubMed
Marchaim, D, Navon-Venezia, S, Schwartz, D, et al. Surveillance cultures and duration of carriage of multidrug-resistant Acinetobacter baumannii . J Clin Microbiol 2007;45:15511555.CrossRefGoogle ScholarPubMed
Supplementary material: Image

Rivera et al. supplementary material

Rivera et al. supplementary material 1

Download Rivera et al. supplementary material(Image)
Image 2.1 MB
Supplementary material: File

Rivera et al. supplementary material

Rivera et al. supplementary material 2

Download Rivera et al. supplementary material(File)
File 18 KB