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Ferjani S, Kanzari L, Maamar E, Hamzaoui Z, Rehaiem A, Ferjani A, Boutiba-Ben Boubaker I. Extensively drug-resistant Acinetobacter baumannii co-producing VIM-2 and OXA-23 in intensive care units: Results of a one-day point prevalence in a Tunisian hospital. Infect Dis Now 2022; 52:426-431. [DOI: 10.1016/j.idnow.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022]
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2
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Atchade E, Goldstein V, Viane S, Van Gysel D, Lolom I, Lortat-Jacob B, Tran-Dinh A, Ben Rehouma M, Lucet JC, Montravers P. Economic impact of an outbreak of carbapenemase producing-Enterobacteriaceae in a surgical intensive care unit. Anaesth Crit Care Pain Med 2022; 41:101093. [PMID: 35504523 DOI: 10.1016/j.accpm.2022.101093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND A 15-month outbreak of carbapenemase-producing Enterobacterales (CPE) occurred in the surgical intensive care unit (SICU) of our institution. We aimed to estimate the financial impact of this outbreak from the perspective of the French public health insurance system. METHODS The characteristics of the colonised/infected CPE patients and outbreak management according to French national guidelines were prospectively collected. Loss of productivity was assessed in terms of the reduction in total number of admissions (TNA) and discharges and in ICU length of stay (LoS). The additional financial burden associated with this outbreak was estimated by the accounting department of the hospital, including the impact of the extended LoS and restricted admissions. RESULTS Sixteen CPE patients (19 stays) were hospitalised in the SICU (10/2016-01/2018). The median ICU LoS for the CPE cases was 17 [8-36] days versus 6.5 and 6.1 days in 2016 and 2017, respectively, for the whole SICU population. The total number of lost bed days during the outbreak was 452. The TNA dropped dramatically in 2017 (decrease of 20.6%). The estimated costs were 768,386 EUR for bed days lost; 297,176 EUR and 63,675 EUR for the extended LoS for the CPE cases and the patients on contact precautions, respectively; 34,045 EUR for staff reinforcements; 85,764 EUR for bacteriological screening tests; and 42,857 EUR for antimicrobial treatment. The total financial burden of the outbreak was 1,291,903 EUR. CONCLUSION Management of a CPE outbreak in the SICU is associated with a huge financial burden for the unit and for the institution.
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Affiliation(s)
- Enora Atchade
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018 Paris, France.
| | - Valérie Goldstein
- APHP, CHU Bichat-Claude Bernard, Unité d'Hygiène et de Lutte contre les Infections Nosocomiales, 46 rue Henri Huchard, 75018 Paris, France
| | - Sophie Viane
- APHP, CHU Bichat-Claude Bernard, Département Activité et Ressources, 46 rue Henri Huchard, 75018 Paris, France
| | - Damien Van Gysel
- APHP, CHU Bichat-Claude Bernard, Département d'Information Médicale, 46 rue Henri Huchard, 75018 Paris, France
| | - Isabelle Lolom
- APHP, CHU Bichat-Claude Bernard, Unité d'Hygiène et de Lutte contre les Infections Nosocomiales, 46 rue Henri Huchard, 75018 Paris, France
| | - Brice Lortat-Jacob
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018 Paris, France
| | - Alexy Tran-Dinh
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018 Paris, France; LVTS, InsermU1148, CHU Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
| | - Mouna Ben Rehouma
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018 Paris, France
| | - Jean-Christophe Lucet
- APHP, CHU Bichat-Claude Bernard, Unité d'Hygiène et de Lutte contre les Infections Nosocomiales, 46 rue Henri Huchard, 75018 Paris, France
| | - Philippe Montravers
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018 Paris, France; Institut National de la Santé et de la Recherche Médicale UMR 1152, Physiopathologie et Epidémiologie des maladies respiratoires, Paris, France
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3
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Duployez C, Le Guern R, Milliere L, Caplan M, Loïez C, Ledoux G, Jaillette E, Favory R, Mathieu D, Wallet F. One Outbreak Could Hide Another. Jpn J Infect Dis 2020; 74:367-368. [PMID: 33250491 DOI: 10.7883/yoken.jjid.2020.705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently a major worldwide concern. Guidelines have been issued regarding precautions for healthcare workers caring for SARS-CoV-2-infected patients. Despite accurate observance of infection control measures, including contact precautions, we encountered an OXA-23-producing Acinetobacter baumannii outbreak in 5 intensive care units of 10 beds each in our tertiary care teaching hospital.
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Affiliation(s)
- Claire Duployez
- Laboratory of Bacteriology, Institute of Microbiology, Lille University Hospital, France.,University of Lille, France
| | - Rémi Le Guern
- Laboratory of Bacteriology, Institute of Microbiology, Lille University Hospital, France.,University of Lille, France
| | - Laurine Milliere
- Laboratory of Bacteriology, Institute of Microbiology, Lille University Hospital, France
| | - Morgan Caplan
- Department of Intensive Care, Lille University Hospital, France
| | - Caroline Loïez
- Laboratory of Bacteriology, Institute of Microbiology, Lille University Hospital, France
| | - Geoffrey Ledoux
- Department of Intensive Care, Lille University Hospital, France
| | | | - Raphaël Favory
- University of Lille, France.,Department of Intensive Care, Lille University Hospital, France
| | - Daniel Mathieu
- University of Lille, France.,Department of Intensive Care, Lille University Hospital, France
| | - Frédéric Wallet
- Laboratory of Bacteriology, Institute of Microbiology, Lille University Hospital, France
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Gagnaire J, Gagneux-Brunon A, Pouvaret A, Grattard F, Carricajo A, Favier H, Mattei A, Pozzetto B, Nuti C, Lucht F, Berthelot P, Botelho-Nevers E. Carbapenemase-producing Acinetobacter baumannii: An outbreak report with special highlights on economic burden. Med Mal Infect 2017; 47:279-285. [PMID: 28343727 DOI: 10.1016/j.medmal.2017.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/31/2016] [Accepted: 02/20/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to describe the management of a carbapenemase-producing Acinetobacter baumannii (CP-AB) outbreak using the Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) statement. We also aimed to evaluate the cost of the outbreak and simulate costs if a dedicated unit to manage such outbreak had been set-up. METHODS We performed a prospective epidemiological study. Multiple interventions were implemented including cohorting measures and limitation of admissions. Cost estimation was performed using administrative local data. RESULTS Five patients were colonized with CP-AB and hospitalized in the neurosurgery ward. The index case was a patient who had been previously hospitalized in Portugal. Four secondary colonized patients were further observed within the unit. The strains of A. baumannii were shown to belong to the same clone and all of them produced an OXA-23 carbapenemase. The closure of the ward associated with the discharge of the five patients in a cohorting area of the Infectious Diseases Unit with dedicated staff put a stop to the outbreak. The estimated cost of this 17-week outbreak was $474,474. If patients had been managed in a dedicated unit - including specific area for cohorting of patients and dedicated staff - at the beginning of the outbreak, the estimated cost would have been $189,046. CONCLUSION Controlling hospital outbreaks involving multidrug-resistant bacteria requires a rapid cohorting of patients. Using simulation, we highlighted cost gain when using a dedicated cohorting unit strategy for such an outbreak.
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Affiliation(s)
- J Gagnaire
- Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - A Gagneux-Brunon
- Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - A Pouvaret
- Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - F Grattard
- Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - A Carricajo
- Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - H Favier
- Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - A Mattei
- Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - B Pozzetto
- Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - C Nuti
- Neurosurgery unit, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - F Lucht
- Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - P Berthelot
- Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France; Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
| | - E Botelho-Nevers
- Infection control unit, infectious diseases department, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France
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5
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Jayaraman SP, Jiang Y, Resch S, Askari R, Klompas M. Cost-Effectiveness of a Model Infection Control Program for Preventing Multi-Drug-Resistant Organism Infections in Critically Ill Surgical Patients. Surg Infect (Larchmt) 2016; 17:589-95. [PMID: 27399263 DOI: 10.1089/sur.2015.222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Interventions to contain two multi-drug-resistant Acinetobacter (MDRA) outbreaks reduced the incidence of multi-drug-resistant (MDR) organisms, specifically methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridium difficile in the general surgery intensive care unit (ICU) of our hospital. We therefore conducted a cost-effective analysis of a proactive model infection-control program to reduce transmission of MDR organisms based on the practices used to control the MDRA outbreak. METHODS We created a model of a proactive infection control program based on the 2011 MDRA outbreak response. We built a decision analysis model and performed univariable and probabilistic sensitivity analyses to evaluate the cost-effectiveness of the proposed program compared with standard infection control practices to reduce transmission of these MDR organisms. RESULTS The cost of a proactive infection control program would be $68,509 per year. The incremental cost-effectiveness ratio (ICER) was calculated to be $3,804 per aversion of transmission of MDR organisms in a one-year period compared with standard infection control. On the basis of probabilistic sensitivity analysis, a willingness-to-pay (WTP) threshold of $14,000 per transmission averted would have a 42% probability of being cost-effective, rising to 100% at $22,000 per transmission averted. CONCLUSIONS This analysis gives an estimated ICER for implementing a proactive program to prevent transmission of MDR organisms in the general surgery ICU. To better understand the causal relations between the critical steps in the program and the rate reductions, a randomized study of a package of interventions to prevent healthcare-associated infections should be considered.
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Affiliation(s)
- Sudha P Jayaraman
- 1 Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University , Richmond, Virginia.,2 Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School , Boston, Massachusetts
| | - Yushan Jiang
- 3 Department of Health Policy and Management and Center for Health Decision Science , Harvard School of Public Health, Boston, Massachusetts
| | - Stephen Resch
- 3 Department of Health Policy and Management and Center for Health Decision Science , Harvard School of Public Health, Boston, Massachusetts
| | - Reza Askari
- 2 Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School , Boston, Massachusetts
| | - Michael Klompas
- 4 Division of Infectious Disease, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, and Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts
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The First Outbreak Caused by Acinetobacter baumannii ST208 and ST195 in China. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9254907. [PMID: 27144176 PMCID: PMC4842041 DOI: 10.1155/2016/9254907] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/25/2016] [Accepted: 03/17/2016] [Indexed: 02/05/2023]
Abstract
This study aimed to analyze the clinical characteristics of patients and molecular mechanisms of the first outbreak mainly caused by sequence types (STs) 208 multidrug resistant (MDR) Acinetobacter baumannii in China. A total of 10 clinical samples were collected from 5 patients who were involved in the outbreak. Bacterial identification and antibiotic sensitivity tests were performed by the VITEK-2 COMPACT automated system. MICs of tigecycline for clinical isolates were determined using broth microdilution. The clonal relatedness of A. baumannii clinical isolates in our local settings was determinated by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). A total of 7 A. baumannii strains were isolated and all were MDR strains; two of them were carbapenem-nonsusceptible strains. bla OXA-23 was the only acquired carbapenemase gene in the isolates. The isolates belonged to a single clonal pulsotype determined by PFGE and two sequences types (STs) determined by MLST. The isolates belonged to the globally disseminated clonal complex 92, among which ST195 and ST208 were the most common sequence types (71.43% and 28.57%). The outbreak was successfully controlled by stringent infection control measures, especially improving the hand hygiene compliance and enhancing antimicrobial stewardship. In conclusion, this is the first description of an outbreak caused mainly by A. baumannii of ST208 in China. Infection control measures should be strengthened when infection outbreaks in hospital.
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7
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Measures to eradicate multidrug-resistant organism outbreaks: how much do they cost? Clin Microbiol Infect 2016; 22:162.e1-162.e9. [DOI: 10.1016/j.cmi.2015.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/28/2015] [Accepted: 10/04/2015] [Indexed: 11/21/2022]
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8
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Birgand G, Leroy C, Nerome S, Luong Nguyen LB, Lolom I, Armand-Lefevre L, Ciotti C, Lecorre B, Marcade G, Fihman V, Nicolas-Chanoine MH, Pelat C, Perozziello A, Fantin B, Yazdanpanah Y, Ricard JD, Lucet JC. Costs associated with implementation of a strict policy for controlling spread of highly resistant microorganisms in France. BMJ Open 2016; 6:e009029. [PMID: 26826145 PMCID: PMC4735214 DOI: 10.1136/bmjopen-2015-009029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess costs associated with implementation of a strict 'search and isolate' strategy for controlling highly drug-resistant organisms (HDRO). DESIGN Review of data from 2-year prospective surveillance (01/2012 to 12/2013) of HDRO. SETTING Three university hospitals located in northern Paris. METHODS Episodes were defined as single cases or outbreaks of glycopeptide-resistant enterococci (GRE) or carbapenemase-producing Enterobacteriacae (CPE) colonisation. Costs were related to staff reinforcement, costs of screening cultures, contact precautions and interruption of new admissions. Univariate analysis, along with simple and multiple linear regression analyses, was conducted to determine variables associated with cost of HDRO management. RESULTS Overall, 41 consecutive episodes were included, 28 single cases and 13 outbreaks. The cost (mean ± SD) associated with management of a single case identified within and/or 48 h after admission was €4443 ± 11,552 and €11,445 ± 15,743, respectively (p<0.01). In an outbreak, the total cost varied from €14,864 ± 17,734 for an episode with one secondary case (€7432 ± 8867 per case) to €136,525 ± 151,231 (€12,845 ± 5129 per case) when more than one secondary case occurred. In episodes of single cases, contact precautions and microbiological analyses represented 51% and 30% of overall cost, respectively. In outbreaks, cost related to interruption of new admissions represented 77-94% of total costs, and had the greatest financial impact (R(2)=0.98, p<0.01). CONCLUSIONS In HDRO episodes occurring at three university hospitals, interruption of new admissions constituted the most costly measure in an outbreak situation.
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Affiliation(s)
- Gabriel Birgand
- INSERM, IAME, UMR 1137, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
- Infection Control Unit, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Christophe Leroy
- Emergency Department, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Simone Nerome
- Infection Control Unit, AP-HP, Hôpital Beaujon, Clichy, France
| | | | - Isabelle Lolom
- Infection Control Unit, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | | | - Céline Ciotti
- Infection Control Unit, AP-HP, Hôpital Beaujon, Clichy, France
| | - Bertrand Lecorre
- Internal Medicine Department, AP-HP, Hôpital Beaujon, Clichy, France
| | - Géraldine Marcade
- Infection Control Unit, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Vincent Fihman
- Infection Control Unit, AP-HP, Hôpital Louis Mourier, Colombes, France
| | | | - Camille Pelat
- INSERM, IAME, UMR 1137, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
| | - Anne Perozziello
- AP-HP, Hôpital Bichat-Claude Bernard, Medical Information Systems Program (PMSI), Paris, France
| | - Bruno Fantin
- Internal Medicine Department, AP-HP, Hôpital Beaujon, Clichy, France
| | - Yazdan Yazdanpanah
- INSERM, IAME, UMR 1137, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
- Infectious Diseases Department, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Jean-Damien Ricard
- INSERM, IAME, UMR 1137, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
- Intensive Care Unit, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Jean-Christophe Lucet
- INSERM, IAME, UMR 1137, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
- Infection Control Unit, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
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Jiang Y, Resch S, Liu X, Rogers SO, Askari R, Klompas M, Jayaraman SP. The Cost of Responding to an Acinetobacter Outbreak in Critically Ill Surgical Patients. Surg Infect (Larchmt) 2015; 17:58-64. [PMID: 26356287 DOI: 10.1089/sur.2015.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Our institution had an outbreak of multi-drug-resistant Acinetobacter (MDRA) in 2011. We analyzed the costs of responding to this outbreak from the hospital's perspective. METHODS We estimated retrospectively the excess costs associated with an MDRA outbreak response at a major academic medical center, including the costs of staffing, supplies, administrative time, deep cleaning, and environmental testing. Differences in mean costs before and during the 2011 MDRA outbreak were analyzed using the Student t-test. RESULTS The overall excess cost incurred during the outbreak response was $371,079 in 2011 U.S. dollars. The largest contributors were the extra resources needed to staff and clean the two intensive care units (ICUs) (78%). In the general surgery ICU, the mean weekly cost of nursing during the outbreak was $13,276 more for regular hours (+15%; p < 0.01) than in the pre-outbreak period and $2,682 more for overtime hours (+86%; p = 0.02). In the trauma ICU, the cost was $20,746 more for regular hours (+24%; p < 0.01) and $3,445 more for overtime hours (+124%; p < 0.01). The costs of supplies ($13,036; +30%; p = 0.03) and gloves ($2,572; +48%; p = 0.01) also were greater during the outbreak. Administrative time, consumables, use of a surge pod, and environmental testing accounted for the remainder of the extra costs. CONCLUSIONS Our institution incurred $371,079 in excess costs as a result of an MDRA outbreak. This figure does not include the costs related to treatment of the infections, loss of reimbursement because of hospital-acquired infection, legal services, or changes in staff morale, patient satisfaction, or hospital reputation. Strategies to prevent and control such outbreaks better have substantial value.
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Affiliation(s)
- Yushan Jiang
- 1 Department of Health Policy and Management and Center for Health Decision Science, Harvard School of Public Health , Boston, Massachusetts
| | - Stephen Resch
- 1 Department of Health Policy and Management and Center for Health Decision Science, Harvard School of Public Health , Boston, Massachusetts
| | - Xiaoxia Liu
- 2 Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School , Boston, Massachusetts
| | - Selwyn O Rogers
- 3 Department of Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Reza Askari
- 2 Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School , Boston, Massachusetts
| | - Michael Klompas
- 4 Division of Infectious Disease, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, and Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts
| | - Sudha P Jayaraman
- 5 Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University , Richmond, Virginia
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Ye D, Shan J, Huang Y, Li J, Li C, Liu X, He W, Li Y, Mao P. A gloves-associated outbreak of imipenem-resistant Acinetobacter baumannii in an intensive care unit in Guangdong, China. BMC Infect Dis 2015; 15:179. [PMID: 25886493 PMCID: PMC4415246 DOI: 10.1186/s12879-015-0917-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/31/2015] [Indexed: 11/17/2022] Open
Abstract
Background Imipenem-resistant Acinetobacter baumannii (IRAB) is an important cause of hospital-acquired infection. We aimed to describe an outbreak of IRAB infection and to investigate its possible source in an intensive care unit. Methods An environmental investigation was undertaken. Antimicrobial susceptibility testing was performed by microdilution. These isolates were genotyped by use of repetitive extragenic palindromic polymerase chain reaction (rep-PCR; DiversiLab). The study included 11 patients infected with IRAB and 14 control patients free of IRAB. Case and control patients were compared for possible predisposing factors. A multifaceted intervention was implemented to control the outbreak. Results Thirty-nine IRABs were isolated from patients and the environmental surveillance culture in August, November, and December 2011. All isolates were resistant to imipenem. The IRAB strains belonged to seven clones (A–G) by the use of rep-PCR. There were four epidemic clones (D–G) in the outbreak, and Clone D was predominant. For the case–control study, patients with chronic obstructive pulmonary disease were susceptible to infection with IRAB. The hospital mortality of the case group was significantly higher than that of the control group. Conclusions The outbreak strains were transmitted among infected patients and equipment by inappropriate use of gloves. A combination of aggressive infection control measures is essential for preventing recurrent nosocomial outbreaks of IRAB.
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Affiliation(s)
- Dan Ye
- Department of Infection Control, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China.
| | - Jinglan Shan
- Department of Infection Control, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China.
| | - Yongbo Huang
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. .,Intensive Care Unit, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China.
| | - Jianchun Li
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. .,Intensive Care Unit, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China.
| | - Changan Li
- Department of Infection Control, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China.
| | - Xiaoqing Liu
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. .,Intensive Care Unit, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China.
| | - Weiqun He
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. .,Intensive Care Unit, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China.
| | - Yimin Li
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China. .,Intensive Care Unit, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China.
| | - Pu Mao
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou medical university, Guangzhou, Guangdong, 510120, China.
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11
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Ece G, Erac B, Yurday Cetin H, Ece C, Baysak A. Antimicrobial Susceptibility and Clonal Relation Between Acinetobacter baumannii Strains at a Tertiary Care Center in Turkey. Jundishapur J Microbiol 2015; 8:e15612. [PMID: 25825641 PMCID: PMC4376970 DOI: 10.5812/jjm.15612] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/16/2014] [Accepted: 03/09/2014] [Indexed: 12/03/2022] Open
Abstract
Background: Acinetobacter baumannii is an opportunistic pathogen, related with nosocomial infections such as bacteremia, urinary tract infections, and ventilator-associated pneumonia. Multidrug resistant (MDR) A. baumannii strains are first line causes of infection, especially in patients hospitalized at intensive care units (ICUs). Infection with MDR A. baumannii strains has a longer duration at ICUs and hospitals. There are studies using molecular methods which can differentiate MDR A. baumannii strains at the clonal level. This helps controlling these resistant strains and prevents their epidemy. Objectives: The aim of our study was to investigate the antimicrobial susceptibility and clonal relationship between the A. baumannii strains isolated from our ICU. Materials and Methods: The identification and antimicrobial susceptibility of 33 A. baumannii strains were performed by automatized Vitek version 2.0. The clonal relationship among A. baumannii strains was analyzed using enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction (PCR). Results: A total of 33 A. baumannii strains were included in this study. A. baumannii complex strains were classified into seven clusters based on the fingerprint results. Our results revealed that two main clusters were responsible for the prevalence of A. baumannii complex strains at the ICU. Conclusions: MDR A. baumannii strains cause an increment in morbidity and mortality, particularly in ICUs. The use of molecular epidemiological methods can help us with the detection of the pathogen and preventing from spreading of these resistant strains.
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Affiliation(s)
- Gulfem Ece
- Department of Medical Microbiology, School of Medicine, Izmir University, Izmir, Turkey
- Corresponding author: Gulfem Ece, Department of Medical Microbiology, Medicalpark Hospital, School of Medicine, Izmir University, Yeni Girne Boulevard, 1825th St., No 12, Karsıyaka, Izmir, Turkey. Tel: +90-2323995050, E-mail: ,
| | - Bayri Erac
- Department of Pharmaceutical Microbiology, School of Pharmacy, Ege University, Izmir, Turkey
| | - Hasan Yurday Cetin
- Department of Anesthesiology and Reanimation, School of Medicine, Izmir University, Izmir, Turkey
| | - Cem Ece
- Department of Anesthesiology and Reanimation, Menemen State Hospital, Izmir, Turkey
| | - Aysegul Baysak
- Department of Chest Diseases, School of Medicine, Izmir University, Izmir, Turkey
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Alfandari S, Gois J, Delannoy PY, Georges H, Boussekey N, Chiche A, Meybeck A, Patoz P, Blondiaux N, Senneville E, Melliez H, Leroy O. Management and control of a carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit. Med Mal Infect 2014; 44:229-31. [PMID: 24840286 DOI: 10.1016/j.medmal.2014.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 03/23/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We had for aim to describe the identification and management of a 14-clonal carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak, following admission of a known CRAB-infected patient in an ICU. METHODS We reviewed the carriers' files and outbreak management procedures. RESULTS The index patient was admitted with strict isolation precautions. The outbreak started 2 months after his discharge. It persisted despite reinforcement of strict isolation precautions, staff and patient cohorting, and extensive environmental decontamination including 2 rounds of routine terminal cleaning and disinfection or 1 round of cleaning and disinfection followed by hydrogen peroxide treatment. A second epidemic peak, after 4 weeks without any case, led to another wide environmental sampling and decontamination rounds. The source of the CRAB outbreak was suspected to be the blood pressure cuffs Velcro. Switching to cuffs submersible in a disinfectant stopped the outbreak. CONCLUSIONS CRAB outbreaks are difficult to manage and sources of persistent colonization can be unexpected.
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Affiliation(s)
- S Alfandari
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France.
| | - J Gois
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France
| | - P-Y Delannoy
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France
| | - H Georges
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France
| | - N Boussekey
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France
| | - A Chiche
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France
| | - A Meybeck
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France
| | - P Patoz
- Laboratoire de biologie, centre hospitalier de Tourcoing, 59208 Tourcoing, France
| | - N Blondiaux
- Laboratoire de biologie, centre hospitalier de Tourcoing, 59208 Tourcoing, France
| | - E Senneville
- Service universitaire des maladies infectieuses et du voyageur, centre hospitalier de Tourcoing, 59208 Tourcoing, France
| | - H Melliez
- Service universitaire des maladies infectieuses et du voyageur, centre hospitalier de Tourcoing, 59208 Tourcoing, France
| | - O Leroy
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France
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Investigation and management of multidrug-resistant Acinetobacter baumannii spread in a French medical intensive care unit: one outbreak may hide another. Am J Infect Control 2013; 41:652-3. [PMID: 23266385 DOI: 10.1016/j.ajic.2012.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 08/02/2012] [Accepted: 08/02/2012] [Indexed: 11/21/2022]
Abstract
An outbreak in a medical intensive care unit was due to an OXA-23-producing Acinetobacter baumannii strain imported from a repatriate hospitalized in Singapore. This outbreak revealed another multidrug resistant epidemic strain that had been present in the hospital for 2 years. Both outbreaks were controlled after 9 months of an extensive infection control program.
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Abstract
Critically ill patients admitted to the intensive care unit (ICU) are frequently treated with antimicrobials. The appropriate and judicious use of antimicrobial treatment in the ICU setting is a constant clinical challenge for healthcare staff due to the appearance and spread of new multiresistant pathogens and the need to update knowledge of factors involved in the selection of multiresistance and in the patient's clinical response. In order to optimize the efficacy of empirical antibacterial treatments and to reduce the selection of multiresistant pathogens, different strategies have been advocated, including de-escalation therapy and pre-emptive therapy as well as measurement of pharmacokinetic and pharmacodynamic (pK/pD) parameters for proper dosing adjustment. Although the theoretical arguments of all these strategies are very attractive, evidence of their effectiveness is scarce. The identification of the concentration-dependent and time-dependent activity pattern of antimicrobials allow the classification of drugs into three groups, each group with its own pK/pD characteristics, which are the basis for the identification of new forms of administration of antimicrobials to optimize their efficacy (single dose, loading dose, continuous infusion) and to decrease toxicity. The appearance of new multiresistant pathogens, such as imipenem-resistant Pseudomonas aeruginosa and/or Acinetobacter baumannii, carbapenem-resistant Gram-negative bacteria harbouring carbapenemases, and vancomycin-resistant Enterococcus spp., has determined the use of new antibacterials, the reintroduction of other drugs that have been removed in the past due to toxicity or the use of combinations with in vitro synergy. Finally, pharmacoeconomic aspects should be considered for the choice of appropriate antimicrobials in the care of critically ill patients.
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Affiliation(s)
- Francisco Álvarez-Lerma
- Service of Intensive Care Medicine, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
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