Abstract
BackgroundThis study was conducted to investigate an outbreak caused by imipenem-resistant Acinetobacter baumannii (IRAB) in a medical intensive care unit (ICU) in a regional hospital.MethodsIn response to an IRAB outbreak from October 2012 to February 2013, we developed several infection control measures, including an extensive review process of environmental cleaning and disinfection, and used molecular methods to identify each clinical and environmental IRAB isolate.ResultsDuring this five-month period, 22 patients were colonized with IRAB and 18 patients had IRAB infections. The in-hospital mortality rate was significantly higher among patients with infections rather than colonizations (44.4% vs 9.1%, p = 0.028). Additionally, nine environmental specimens, including five specimens collected after terminal disinfection, were positive for IRAB. 12 environmental isolates and 28 of 36 available clinical isolates belonged to one unique pulsotype A, which was confirmed by molecular methods. We found the concentration of disinfectant, 0.08% sodium hypochlorite, was inadequate. After correcting the environmental cleansing methods, the surveillance study showed no further IRAB isolates on the control panel surfaces of the medical equipment or in patients in the ICU. Additionally, an in vitro study of IRAB immersed in different concentrations of sodium hypochlorite showed that 0.5% sodium hypochlorite eradicates IRAB after 30 seconds of inoculation, but 0.08% sodium hypochlorite only reduces the bacterial load.ConclusionsThis study highlights the importance of the preparation of disinfectants to adequately achieve environmental disinfection in the control of IRAB outbreaks in the ICU.
Highlights
Acinetobacter baumannii, a non-fermenting Gram-negative coccobacillus has become an important nosocomial pathogen, especially in intensive care units (ICUs)
Because A. baumannii has a great ability to colonize humans and environmental surfaces [3,4], it is difficult to eradicate this pathogen from the environment
Setting Chi Mei Medical Center, Liouying campus is a 900-bed regional hospital located in southern Taiwan with a 16-bed medical ICU
Summary
Acinetobacter baumannii, a non-fermenting Gram-negative coccobacillus has become an important nosocomial pathogen, especially in intensive care units (ICUs). The increasing appearance of multiple drug resistance in this pathogen, especially carbapenem-resistance, limits the therapeutic antibiotic options for patients infected with A. baumannii. Most importantly, this multidrug resistant (MDR) pathogen can cause healthcare-associated infections and can increase mortality and the length of stay in the ICU [1,2]. It can cause life-threatening human infections, especially in immunocompromised and critically ill patients. This study was conducted to investigate an outbreak caused by imipenem-resistant Acinetobacter baumannii (IRAB) in a medical intensive care unit (ICU) in a regional hospital
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