一家综合性教学医院暴发泛耐药鲍曼不动杆菌感染

David

Infect Control Hosp Epidemiol 2009;30:257–263 © 2009 by The Society for Healthcare Epidemiology of America. All rights reserved.
0899-823X/2009/3003-0008$15.00
DOI: 10.1086/595977

Original Article
Nosocomial Outbreak of Infection With Pan–Drug-Resistant Acinetobacter baumannii in a Tertiary Care University Hospital一家综合性教学医院暴发泛耐药鲍曼不动杆菌感染
Raquel Valencia, MD, MPH;
Luis A. Arroyo, MD;
Manuel Conde, MD, MPH, PhD;
Josefa M. Aldana, MD, MPH;
María-José Torres, PhD;
Felipe Fernández-Cuenca, PhD;
José Garnacho-Montero, MD, PhD;
José M. Cisneros, MD, PhD;
Carlos Ortíz, MD, PhD;
Jerónimo Pachón, MD, PhD;
Javier Aznar, MD, PhD
From the Preventive Medicine and Public Health Service (R.V., M.C., J.M.A.), the Clinical Microbiology Service (L.A.A., J.A.), the Intensive Care Service (J.G.-M., C.O.), and the Infectious Diseases Service (J.M.C., J.P.), Virgen del Rocío University Hospitals, and the Departments of Preventive Medicine (R.V., M.C.), Microbiology (M.-J.T., F.F.-C., J.A.), and Medicine (J.P.), the University of Seville, Spain.
Objective.

                               
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To describe what is, to our knowledge, the first nosocomial outbreak of infection with pan–drug-resistant (including colistin-resistant) Acinetobacter baumannii, to determine the risk factors associated with these types of infections, and to determine their clinical impact.

Design.

                               
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Nested case-control cohort study and a clinical-microbiological study.

Setting.

                               
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A 1,521-bed tertiary care university hospital in Seville, Spain.

Patients.

                               
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Case patients were inpatients who had a pan–drug-resistant A. baumannii isolate recovered from a clinical or surveillance sample obtained at least 48 hours after admission to an intensive care unit (ICU) during the time of the epidemic outbreak. Control patients were patients who were admitted to any of the “boxes” (ie, rooms that partition off a distinct area for a patient's bed and the equipment needed to care for the patient) of an ICU for at least 48 hours during the time of the epidemic outbreak.

Results.

                               
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All the clinical isolates had similar antibiotic susceptibility patterns (ie, they were resistant to all the antibiotics tested, including colistin), and, on the basis of repetitive extragenic palindromic–polymerase chain reaction, it was determined that all of them were of the same clone. The previous use of quinolones and glycopeptides and an ICU stay were associated with the acquisition of infection or colonization with pan–drug-resistant A. baumannii. To control this outbreak, we implemented the following multicomponent intervention program: the performance of environmental decontamination of the ICUs involved, an environmental survey, a revision of cleaning protocols, active surveillance for colonization with pan–drug-resistant A. baumannii, educational programs for the staff, and the display of posters that illustrate contact isolation measures and antimicrobial use recommendations.

Conclusions.

                               
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We were not able to identify the common source for these cases of infection, but the adopted measures have proven to be effective at controlling the outbreak.