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Cross-Transmission of Multidrug-Resistant Acinetobacter baumannii Clonal Strains Causing Episodes of Sepsis in a Trauma Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Antonios Markogiannakis ,
George Fildisis ,
Sofia Tsiplakou ,
Alexandras Ikonomidis ,
Alexandra Koutsoukou ,
Spyros Pournaras ,
Evangelos N. Manolis ,
George Baltopoulos  and
Athanassios Tsakris
Antonios Markogiannakis
Affiliation:
Department of Basic Sciences, School of Health Sciences, University of Athens
George Fildisis
Affiliation:
Nursing School University Intensive Care Unit, General Hospital of Attica KAT, Athens
Sofia Tsiplakou
Affiliation:
Department of Microbiology, General Hospital of Attica KAT, Athens
Alexandras Ikonomidis
Affiliation:
Department of Medical Microbiology, University of Thessaly, Larissa, Greece
Alexandra Koutsoukou
Affiliation:
Department of Microbiology, General Hospital of Attica KAT, Athens
Spyros Pournaras
Affiliation:
Department of Medical Microbiology, University of Thessaly, Larissa, Greece
Evangelos N. Manolis
Affiliation:
Department of Basic Sciences, School of Health Sciences, University of Athens
George Baltopoulos
Affiliation:
Nursing School University Intensive Care Unit, General Hospital of Attica KAT, Athens
Athanassios Tsakris*
Affiliation:
Department of Microbiology, Medical School, University of Athens
*
Department of Microbiology, Medical School, University of Athens, 115 27 Athens, Greece, (atsakris@med.uoa.gr)
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Abstract

Objective.

To investigate the mode of transmission of imipenem-resistant Acinetobacter baumannii strains causing episodes of sepsis.

Setting.

A 7-bed trauma intensive care unit (ICU) in an orthopedic hospital in Greece.

Design.

During a 14-week period (from January 10 to April 16, 2006), clinical specimens, along with samples taken on a weekly basis from the ICU environment and from the hands of health care workers (HCWs), were prospectively tested for imipenem-resistant A. baumannii. Pulsed-field gel electrophoresis was used to study the genetic relatedness of the isolates recovered from these specimens and samples.

Results.

During the survey, imipenem-resistant A. baumannii was identified in 14 hospitalized patients, from whom 40 multidrug-resistant and imipenem-resistant A. baumanii isolates were recovered. These pathogens caused episodes of bacteremia and sepsis in all but one of the patients and contributed to the death of 3 patients. Samples for culture were obtained from the environment and from the hands of HCWs; 29 imipenem-resistant A. baumannii isolates were recovered from the environment, and 12 from HCWs. One predominant genotype and 2 less predominant genotypes were detected among the 81 imipenem-resistant A. baumannii isolates. All 3 of these genotypes were found among patients and HCWs and were recovered from environmental samples.

Interventions.

Control measures consisted of the closure of the ICU and the transfer of the patients to other units. The ICU was disinfected, and adherence to proper hand hygiene protocol was reinforced. These same clonal isolates were not recovered from clinical or environmental samples during the month after the reopening of the ICU.

Conclusions.

The extensive dissemination of imipenem-resistant A. baumannii clonal strains causing episodes of bacteremia and/or sepsis resulted from modes of transmission via multiple contaminated surfaces and objects and transiently colonized HCWs' hands. Closure of the ICU and its meticulous environmental decontamination led to the successful control of the outbreak.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 5 , May 2008 , pp. 410 - 417
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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