Carbapenem-Resistant Actinetobacter Baumannii Transmission Containment in a Ventilator Skilled Nursing Facility

Abstract

Background Actinetobacter baumannii are Gram-negative bacteria that can cause urinary, bloodstream, lung, wound, and other infections. In August 2020, the Louisiana Department of Health (LDH) was notified of three patients who were infected with carbapenem-resistant A. baumannii and were hospitalized at an acute care hospital within four weeks. They originated from the same ventilator skilled nursing facility (vSNF). LDH epidemiologists initiated a response consistent with CDC's national containment strategy to combat antibiotic resistant threats. Methods An in-person infection control assessment and response (ICAR) survey with rounding was conducted within five days of notification of the cluster. Interim infection control recommendations included implementing a policy for the removal of gel polish and acrylic nails, auditing of environmental cleaning practices, and reinforcing infection control competencies. Isolates were forwarded to the CDC Southeast Antibiotic Resistance Laboratory (ARLN) for pulse field gel electrophoresis and enhanced sensitivity testing. The facility agreed to colonization screening for the ventilator unit where all of the cases were previously housed. Swabs shipment was coordinated, and candidate screening patients were identified. Results Preliminary comparisons of antibiotic sensitivity results of cases showed similar resistance patterns for nine antibiotics, of which one was a carbapenem (meropenem). Two of the three index cases were confirmed for pan-resistant A. baumannii and positive for the OXA-23 gene on the CDC assay from respiratory and bronchiolar lavage specimens. Two rounds of colonization screenings were conducted greater than two weeks apart among four testing candidates each. No additional cases of A. baumannii, or any other multi drug-resistant pathogen, were identified. Conclusions Swift public health coordination is necessary for the containment of multi drug-resistant threats when introduced into congregate healthcare settings. While colonization screening results for this facility were encouraging, infection control recommendations and policy interventions were needed to prevent the spread of additional pathogens among vulnerable ventilated and non-ventilated patients. Actinetobacter baumannii are Gram-negative bacteria that can cause urinary, bloodstream, lung, wound, and other infections. In August 2020, the Louisiana Department of Health (LDH) was notified of three patients who were infected with carbapenem-resistant A. baumannii and were hospitalized at an acute care hospital within four weeks. They originated from the same ventilator skilled nursing facility (vSNF). LDH epidemiologists initiated a response consistent with CDC's national containment strategy to combat antibiotic resistant threats. An in-person infection control assessment and response (ICAR) survey with rounding was conducted within five days of notification of the cluster. Interim infection control recommendations included implementing a policy for the removal of gel polish and acrylic nails, auditing of environmental cleaning practices, and reinforcing infection control competencies. Isolates were forwarded to the CDC Southeast Antibiotic Resistance Laboratory (ARLN) for pulse field gel electrophoresis and enhanced sensitivity testing. The facility agreed to colonization screening for the ventilator unit where all of the cases were previously housed. Swabs shipment was coordinated, and candidate screening patients were identified. Preliminary comparisons of antibiotic sensitivity results of cases showed similar resistance patterns for nine antibiotics, of which one was a carbapenem (meropenem). Two of the three index cases were confirmed for pan-resistant A. baumannii and positive for the OXA-23 gene on the CDC assay from respiratory and bronchiolar lavage specimens. Two rounds of colonization screenings were conducted greater than two weeks apart among four testing candidates each. No additional cases of A. baumannii, or any other multi drug-resistant pathogen, were identified. Swift public health coordination is necessary for the containment of multi drug-resistant threats when introduced into congregate healthcare settings. While colonization screening results for this facility were encouraging, infection control recommendations and policy interventions were needed to prevent the spread of additional pathogens among vulnerable ventilated and non-ventilated patients.