Dataset Information

Faucet aerators as a reservoir for Carbapenem-resistant Acinetobacter baumannii: a healthcare-associated infection outbreak in a neurosurgical intensive care unit.

ABSTRACT: Background:On January 7, 2019, we observed an outbreak of healthcare-associated infection (HAI) caused by Carbapenem-resistant Acinetobacter baumannii (CRAB) in the neurosurgical intensive care unit (NSICU). A follow-up epidemiological investigation was conducted, and an emergency response was initiated. We aimed to study the clonal transmission of CRAB and its possible source. Methods:A matched case-control (1:2) study was performed to identify the possible predisposing factors. A multifaceted intervention was implemented to control the outbreak. We collected environmental samples from patients' rooms and living area of the staff. CRAB isolates were tested for genetic relatedness by Pulsed-Field Gel Electrophoresis (PFGE). Results:Environmental sampling showed that a faucet aerator was contaminated with A. baumannii. Molecular typing revealed the only outbreak strain, which was isolated from tracheal aspirate cultures of the first case of community-acquired infection and 3 cases of HAI. In environmental samples, the outbreak strain was found only in the faucet aerator of the dining room. This CRAB outbreak was discovered in time, and further progress of this outbreak was prevented through a pre-set emergency response procedure. Conclusions:The faucet aerator acted as a reservoir for bacteria in the outbreak, and contamination of the faucet aerator might have occurred from splashes originating from handwashing by the healthcare workers (HCWs). In high-risk areas, such as NSICU, the faucet aerators should not be used during an outbreak or they should be regularly cleaned and disinfected. The start-up criteria for the emergency response played a key role in controlling the CRAB outbreak, and its settings should be discussed more widely.

SUBMITTER: Lv Y

PROVIDER: S-EPMC6938019 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Faucet aerators as a reservoir for Carbapenem-resistant <i>Acinetobacter baumannii</i>: a healthcare-associated infection outbreak in a neurosurgical intensive care unit.

Lv Yu Y Xiang Qian Q Jin Ying Z YZ Fang Ying Y Wu Yu J YJ Zeng Bin B Yu Hua H Cai Hong M HM Wei Qiong D QD Wang Chen C Chen Jing J Wang Hui H

Antimicrobial resistance and infection control 20191230

<h4>Background</h4>On January 7, 2019, we observed an outbreak of healthcare-associated infection (HAI) caused by Carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB) in the neurosurgical intensive care unit (NSICU). A follow-up epidemiological investigation was conducted, and an emergency response was initiated. We aimed to study the clonal transmission of CRAB and its possible source.<h4>Methods</h4>A matched case-control (1:2) study was performed to identify the possible predisposing fa ...[more]

PMID: 31893039

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Project description:Acinetobacter baumannii is a common cause of healthcare-associated infections (HAI) worldwide, mostly occurring in intensive care units (ICUs). Extended-spectrum beta lactamases (ESBL)-positive A. baumannii strains have emerged as highly resistant to most currently used antimicrobial agents, including carbapenems. The most common mechanism for carbapenem resistance in this species is β-lactamase-mediated resistance. Carbapenem-hydrolyzing class D oxacillinases are widespread among multidrug-resistant (MDR) A. baumannii strains. The present study was conducted to determine the presence and distribution of blaOXA genes among multidrug-resistant A. baumannii isolated from ICU patients and genes encoding insertion sequence (IS-1) in these isolates. Additionally, the plasmid DNA profiles of these isolates were determined. A total of 120 clinical isolates of A. baumannii from various ICU clinical specimens of four main Jordanian hospitals were collected. Bacterial isolate identification was confirmed by biochemical testing and antibiotic sensitivity was then assessed. PCR amplification and automated sequencing were carried out to detect the presence of blaOXA-51, blaOXA-23, blaOXA-24, and blaOXA-58 genes, and ISAba1 insertion sequence. Out of the 120 A. baumannii isolates, 95% of the isolates were resistant to three or more classes of the antibiotics tested and were identified as MDR. The most frequent resistance of the isolates was against piperacillin (96.7%), cephalosporins (97.5%), and β-lactam/β-lactamase inhibitor combinations antibiotics (95.8%). There were 24 (20%) ESBL-producing isolates. A co-existence of blaOXA-51 gene and ISAba1 in all the 24 ESBL-producing isolates was determined. In addition, in the 24 ESBL-producing isolates, 21 (87.5%) carried blaOXA-51 and blaOXA-23 genes, 1 (4.2%) carried blaOXA-51 and blaOXA-24, but all were negative for the blaOXA-58 gene. Plasmid DNA profile A and profile B were the most common (29%) in ESBL-positive MDR A. baumannii isolates while plasmid DNA profile A was the most common in the ESBL-negative isolates. In conclusion, there was an increase in prevalence of MDR-A. baumannii in ICU wards in Jordanian hospitals, especially those having an ESBL phenotype. Thus, identification of ESBL genes is necessary for the surveillance of their transmission in hospitals.

Project description:BackgroundWith an increase in the use of colistin methansulfonate (CMS) to treat carbapenem-resistant Acinetobacter baumannii infections, colistin resistance is emerging.MethodsPatients with infection or colonization due to colistin-resistant A. baumannii were identified at a hospital system in Pennsylvania. Clinical data were collected from electronic medical records. Susceptibility testing, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST) were performed. To investigate the mechanism of colistin resistance, lipid A was subjected to matrix-assisted laser desorption/ionization mass spectrometry.ResultsTwenty patients with colistin-resistant A. baumannii were identified. Ventilator-associated pneumonia was the most common type of infection. Nineteen patients had received intravenous and/or inhaled CMS for treatment of carbapenem-resistant, colistin-susceptible A. baumannii infection prior to identification of colistin-resistant isolates. The 30-day all-cause mortality rate was 30%. The treatment regimen for colistin-resistant A. baumannii infection associated with the lowest mortality rate was a combination of CMS, a carbapenem, and ampicillin-sulbactam. The colistin-susceptible and -resistant isolates from the same patients were highly related by PFGE, but isolates from different patients were not, suggesting evolution of resistance during CMS therapy. By MLST, all isolates belonged to the international clone II, the lineage that is epidemic worldwide. Phosphoethanolamine modification of lipid A was present in all colistin-resistant A. baumannii isolates.ConclusionsColistin-resistant A. baumannii occurred almost exclusively among patients who had received CMS for treatment of carbapenem-resistant, colistin-susceptible A. baumannii infection. Lipid A modification by the addition of phosphoethanolamine accounted for colistin resistance. Susceptibility testing for colistin should be considered for A. baumannii identified from CMS-experienced patients.

Dataset Information

Faucet aerators as a reservoir for Carbapenem-resistant Acinetobacter baumannii: a healthcare-associated infection outbreak in a neurosurgical intensive care unit.

Publications

Faucet aerators as a reservoir for Carbapenem-resistant <i>Acinetobacter baumannii</i>: a healthcare-associated infection outbreak in a neurosurgical intensive care unit.

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