1
|
Grupel D, Borer A, Yosipovich R, Nativ R, Sagi O, Saidel-Odes L. A multi-layered infection control intervention on carbapenem-resistant Acinetobacter baumannii acquisition: an interrupted time series. Am J Infect Control 2024:S0196-6553(24)00685-0. [PMID: 39182848 DOI: 10.1016/j.ajic.2024.08.018] [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: 06/19/2024] [Revised: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAB) causes life-threating hospital-acquired infections in critically-ill patients. Due to a limited number of Intensive-Care-Unit (ICU) beds, these patients are often treated in high-dependency (HD) non-ICUs within internal-medicine wards (IMW) in Israel. We aimed to assess the effectiveness of a multi-layered infection-control intervention on CRAB infection-rate in IMWs, especially in its HD non-ICUs with ongoing CRAB transmission. METHODS A quasi-experimental, before-and-after, interrupted time-series study with control outcomes conducted from January 2019 through June 2022. We conducted a multi-layered intervention over 3.5 years which included 4 phases: 1) Pre-intervention; 2) Intervention-introduction: introduced enhanced environment cleaning; 3) Intervention phase 1: introduced active surveillance; 4) Intervention phase 2: introduced CRAB-positive patient cohorting, in addition to previous ongoing measures taken. RESULTS CRAB was isolated from 204 patients aged 69.8y/o ± 15.86y, 59.8% male. CRAB-positive clinical samples were found in 34.3% of these patients. Mean hospital length-of-stay was 30.5 days, with a 30-day post-discharge mortality-rate of 55.9%. Mean CRAB clinical cases decreased from 0.89 in pre-intervention to 0.11 at the end of Phase 2, with a change in slope and level after the intervention of p= 0.02 (CI: -0.204- to -0.040) and p=0.004 (CI: -0.013 to -0.003), respectively. CONCLUSIONS This multi-layered intervention, including enhanced environment cleaning, active surveillance, and patient cohorting, successfully reduced CRAB acquisition in IMWs and their HD non-ICUs.
Collapse
Affiliation(s)
- Daniel Grupel
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Abraham Borer
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Riki Yosipovich
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ronit Nativ
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Orli Sagi
- Clinical Microbiology Labratory, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lisa Saidel-Odes
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| |
Collapse
|
2
|
Keck JM, Viteri A, Schultz J, Fong R, Whitman C, Poush M, Martin M. New Agents Are Coming, and So Is the Resistance. Antibiotics (Basel) 2024; 13:648. [PMID: 39061330 PMCID: PMC11273847 DOI: 10.3390/antibiotics13070648] [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: 06/25/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Antimicrobial resistance is a global threat that requires urgent attention to slow the spread of resistant pathogens. The United States Centers for Disease Control and Prevention (CDC) has emphasized clinician-driven antimicrobial stewardship approaches including the reporting and proper documentation of antimicrobial usage and resistance. Additional efforts have targeted the development of new antimicrobial agents, but narrow profit margins have hindered manufacturers from investing in novel antimicrobials for clinical use and therefore the production of new antibiotics has decreased. In order to combat this, both antimicrobial drug discovery processes and healthcare reimbursement programs must be improved. Without action, this poses a high probability to culminate in a deadly post-antibiotic era. This review will highlight some of the global health challenges faced both today and in the future. Furthermore, the new Infectious Diseases Society of America (IDSA) guidelines for resistant Gram-negative pathogens will be discussed. This includes new antimicrobial agents which have gained or are likely to gain FDA approval. Emphasis will be placed on which human pathogens each of these agents cover, as well as how these new agents could be utilized in clinical practice.
Collapse
Affiliation(s)
- J. Myles Keck
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Alina Viteri
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | | | - Rebecca Fong
- Department of Pharmacy, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
| | - Charles Whitman
- Department of Pharmacy, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
| | - Madeline Poush
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Marlee Martin
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| |
Collapse
|
3
|
Margalit I, Kunwar D, Gadot C, Meroi M, Scardellato R, Zamir A, Koutsolioutsou A, Goldberg E, Righi E, Yahav D. Clinical impact of active screening cultures for carbapenem-resistant Acinetobacter baumannii: A systematic review and meta-analysis. Am J Infect Control 2024:S0196-6553(24)00578-9. [PMID: 38936479 DOI: 10.1016/j.ajic.2024.06.017] [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: 04/11/2024] [Revised: 06/22/2024] [Accepted: 06/23/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a significant health care-associated infection carrying substantial mortality. We assessed the clinical impact of active screening cultures for CRAB. METHODS A systematic review and meta-analysis, aiming to answer 2 questions: (1) Does screening versus no screening improve clinical outcomes? (2) Does positive screening ("CRAB carrier") predict CRAB infections? We searched the literature until January 2024 for comparative studies reporting clinical outcomes (mortality, invasive CRAB infections). RESULTS Of 5,407 screened publications, 9 studies (10,865 individuals) were included. Invasive CRAB infection rate was significantly higher among CRAB carriers (OR 11.14, 95% CI 4.95-25.05, with substantial heterogeneity stemming from size rather than direction of the effect). Negative predictive value of noncarriage for invasive infection was 97%. CRAB bloodstream infection rate was significantly higher among carriers (odds ratio 16.23, 95% confidence interval 2.9-110.08). No difference was demonstrated between the groups for CRAB ventilator-associated pneumonia, length of stay, and mortality. Only 1 study reported outcomes for study question #1. CONCLUSIONS Data to support active CRAB screening are scarce regarding its clinical benefit for patients. Positively screened patients are at significantly higher risk for invasive CRAB infections, with high negative predictive value for noncarriage. This did not translate to reduced mortality.
Collapse
Affiliation(s)
- Ili Margalit
- Infectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
| | | | - Chen Gadot
- Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Marco Meroi
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Verona, Italy
| | - Rebecca Scardellato
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Verona, Italy
| | - Amber Zamir
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Anastasia Koutsolioutsou
- Deptment of Environmental Health and Monitoring of Smoking Secession, National Public Health Organization, Athens, Greece
| | - Elad Goldberg
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel; Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Elda Righi
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Verona, Italy
| | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Marusinec R, Shemsu M, Lloyd T, Kober BM, Heaton DT, Herrera JA, Gregory M, Varghese V, Nadle J, Trivedi KK. Epidemiology of carbapenem-resistant organisms in Alameda County, California, 2019-2021. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e64. [PMID: 38698944 PMCID: PMC11062789 DOI: 10.1017/ash.2024.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 05/05/2024]
Abstract
Objective Carbapenem-resistant organisms (CROs) are an urgent health threat. Since 2017, Alameda County Health Public Health Department (ACPHD) mandates reporting of carbapenem-resistant Enterobacterales (CRE) and encourages voluntary reporting of non-CRE CROs including carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA). Surveillance data from ACPHD were analyzed to describe the epidemiology of CROs and target public health interventions. Methods Healthcare facilities in Alameda County reported CRO cases and submitted isolates to ACPHD to characterize carbapenemase genes; deaths were identified via the California Electronic Death Registration System. CRO cases with isolates resistant to one or more carbapenems were analyzed from surveillance data from July 2019 to June 2021. Results Four hundred and forty-two cases of CROs were reported to Alameda County from 408 patients. The county case rate for CROs was 29 cases per 100,000 population, and cases significantly increased over the 2-year period. CRPA was most commonly reported (157 cases, 36%), and cases of CRAB increased 1.83-fold. One-hundred eighty-six (42%) cases were identified among residents of long-term care facilities; 152 (37%) patients had died by January 2022. One hundred and seven (24%) cases produced carbapenemases. Conclusions The high burden of CROs in Alameda County highlights the need for continued partnership on reporting, testing, and infection prevention to limit the spread of resistant organisms. A large proportion of cases were identified in vulnerable long-term care residents, and CRAB was an emerging CRO among this population. Screening for CROs and surveillance at the local level are important to understand epidemiology and implement public health interventions.
Collapse
Affiliation(s)
- Rachel Marusinec
- Alameda County Health, Public Health Department, Division of Communicable Disease Control and Prevention, San Leandro, CA, USA
| | - Munira Shemsu
- Alameda County Health, Public Health Department, Division of Communicable Disease Control and Prevention, San Leandro, CA, USA
| | - Tyler Lloyd
- Alameda County Health, Public Health Department, Public Health Laboratory, Oakland, CA, USA
| | - Brendan M. Kober
- Alameda County Health, Public Health Department, Division of Communicable Disease Control and Prevention, San Leandro, CA, USA
| | - Dustin T. Heaton
- Alameda County Health, Public Health Department, Division of Communicable Disease Control and Prevention, San Leandro, CA, USA
| | - Jade A. Herrera
- Alameda County Health, Public Health Department, Division of Communicable Disease Control and Prevention, San Leandro, CA, USA
| | - Misha Gregory
- Alameda County Health, Public Health Department, Division of Communicable Disease Control and Prevention, San Leandro, CA, USA
| | - Vici Varghese
- Alameda County Health, Public Health Department, Public Health Laboratory, Oakland, CA, USA
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, CA, USA
| | - Kavita K. Trivedi
- Alameda County Health, Public Health Department, Division of Communicable Disease Control and Prevention, San Leandro, CA, USA
| |
Collapse
|
5
|
Lellouche J, Keren-Paz A, Rov R, Efrati Epchtien R, Frenk S, Hameir A, Temkin E, Schwartz D, Carmeli Y. Carbapenem-resistant Acinetobacter baumannii carrier detection: a simple and efficient protocol. Microbiol Spectr 2024; 12:e0406223. [PMID: 38426764 PMCID: PMC10986532 DOI: 10.1128/spectrum.04062-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
Timely detection of carbapenem-resistant Acinetobacter baumannii (CRAB) carriers is essential to direct infection control measures. In this work, we aimed to develop a practical protocol to detect CRAB from screening samples. To choose a selective medium that detects CRAB with high sensitivity and specificity, 111 A. baumannii clinical isolates were inoculated on three types of agar: mSuperCARBA (SC), CHROMagar Acinetobacter (CaA), and modified CHROMagar Acinetobacter (mCaA) containing 4.5 mg/mL meropenem. SC was non-selective, CaA was the most sensitive (100%), but only moderately specific (72%), and mCaA was highly specific (97%) and sensitive (98%). Confirmation of the carbapenem-resistant phenotype using PCR-based detection of blaOXA-23, blaOXA-24, and blaOXA-58 genes was specific but not sensitive, detecting only 58% of CRAB isolates. Identification of A. baumannii using either gyrB or blaOXA-51 PCR was excellent. Next, we used the same methodology in routine screening for CRAB carriage. mCaA had the best yield, with high sensitivity but moderate specificity to differentiate between CRAB and other carbapenem-resistant organisms. Skin sampling using sponges and 6 hour enrichment was highly sensitive (98%), while other body sites had poor sensitivity (27%- 41%). Shorter incubation had slightly lower yield, and longer incubation did not improve the detection. Performing PCR for blaOXA-51 and gyrB on colonies growing on modified mCaA differentiated between CRAB and other species with high accuracy (98% and 99%, respectively). Based on our results, we present a procedure for easy and reliable detection of CRAB carriage using skin sampling, short enrichment, selection on mCaA, and PCR-based identification. IMPORTANCE Carbapenem-resistant Acinetobacter baumannii (CRAB) is a substantial cause of nosocomial infections, classified among the most significant multidrug-resistant pathogens by the World Health Organization and by the US Centers for Disease Control. Limiting the spread of CRAB is an important goal of infection control, but laboratory methods for identification of CRAB carriers are not standardized. In this work, we compared different selective agar plates, tested the efficiency of A. baumannii identification by PCR for species-specific genes, and used PCR-based detection of common resistance genes to confirm the carbapenem-resistant phenotype. During a prospective study, we also determined the optimal sample enrichment time. Based on our results, we propose a simple and efficient protocol for the detection of CRAB carriage using skin sampling, short enrichment, selection on appropriate agar plates, and PCR-based identification, resulting in a turn-around time of 24 hours.
Collapse
Affiliation(s)
- Jonathan Lellouche
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Alona Keren-Paz
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Reut Rov
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Reut Efrati Epchtien
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Sammy Frenk
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Amichay Hameir
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Elizabeth Temkin
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - David Schwartz
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Yehuda Carmeli
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| |
Collapse
|
6
|
Zheng C, Li D, Wang Y, Wang L, Huang Y, Yao J. Risk factors and genetic characteristics of the carriage of hypervirulent and carbapenem-resistant Acinetobacter baumannii among pregnant women. Front Microbiol 2024; 15:1351722. [PMID: 38572236 PMCID: PMC10987950 DOI: 10.3389/fmicb.2024.1351722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/16/2024] [Indexed: 04/05/2024] Open
Abstract
Background Carbapenem-resistant Acinetobacter baumannii (CRAB) and its emerging evolutionary branch toward hypervirulence have been neglected in pregnancy. Methods From September 2020 to August 2021, an active surveillance culture program encompassed 138 randomly selected pregnant women, with five subjected to sample collection at two different time points. The clinical characterization was explored through statistical analysis. Whole-genome sequencing, a Galleria mellonella infection model, and a global database were used to investigate the genetic characterization, pathogenicity, evolutionary history, and phylogenetic relationships of the isolates. Results Of the 41 CRAB isolates obtained, they were divided into four ClustersRS and an orphan pattern. ClusterRS 1 (n = 31), with eight complex types in pregnancy, was also the dominant ClusterRS globally, followed by ClusterRS 13 (n = 5), identified as hypervirulent KL49 CRAB, exhibiting phylogeographical specificity to Guangdong. A maternal carriage CRAB rate of 26.09% (36/138) was revealed, with half of the isolates representing novel complex types, prominently including CT3071, as the first KL7 isolates identified in Shenzhen. Both KL49 and KL7 isolates were most commonly found in the same participant, suggesting potential intraspecific competition as a possible reason for CRAB infection without carriers during pregnancy. The independent risk factors for carriers were revealed for the first time, including advanced maternal age, gestational diabetes mellitus, and Group B Streptococcus infection. Conclusion The significant carriage rate and enhanced virulence of CRAB during pregnancy emphasize the imperative for routine surveillance to forestall dissemination within this high-risk group, especially in Guangdong for ClusterRS 13 isolates.
Collapse
Affiliation(s)
- Chao Zheng
- Department of Gastroenterology, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
- Bacteriology and Antibacterial Resistance Surveillance Laboratory, Shenzhen Institute of Respiratory Disease, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
- Integrated Chinese and Western Medicine Postdoctoral Research Station, Jinan University, Guangzhou, China
- School of Materials and Environmental Engineering, Shenzhen Polytechnic University, Shenzhen, China
| | - Defeng Li
- Department of Gastroenterology, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Yinglan Wang
- Department of Obstetrics and Gynecology, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Lisheng Wang
- Department of Gastroenterology, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Yuting Huang
- Bacteriology and Antibacterial Resistance Surveillance Laboratory, Shenzhen Institute of Respiratory Disease, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
- Department of Head and Neck Surgery, Cancer Hospital Chinese Academy of Medical Sciences Shenzhen Center, Shenzhen, China
| | - Jun Yao
- Department of Gastroenterology, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| |
Collapse
|
7
|
Nutman A, Levi GD, Keren-Paz A, Schwartz D, Masarwa S, Schechner V, Carmeli Y. Active surveillance for carbapenem-resistant Acinetobacter baumannii (CRAB) carriage. Microbiol Spectr 2023; 11:e0314623. [PMID: 37943045 PMCID: PMC10715071 DOI: 10.1128/spectrum.03146-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/01/2023] [Indexed: 11/10/2023] Open
Abstract
IMPORTANCE Our study's results provide promising evidence for the incorporation of a high-sensitivity carbapenem-resistant Acinetobacter baumannii (CRAB) screening method in healthcare settings. Such an approach could prove beneficial in enhancing infection prevention and control measures, leading to improved patient outcomes and potentially alleviating the burden of CRAB in healthcare systems.
Collapse
Affiliation(s)
- Amir Nutman
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabrielle D. Levi
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alona Keren-Paz
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - David Schwartz
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Samira Masarwa
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Vered Schechner
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Carmeli
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
Harris AD, Pineles L, Johnson JK, O’Hara LM, Smith LL, French I, Rubin J, Perlmutter R, Heller A, Klein L, Thoguru J, Blythe D, Vaeth E. Prevalence of Acinetobacter baumannii and Candida auris in Patients Receiving Mechanical Ventilation. JAMA 2023; 330:1769-1772. [PMID: 37824710 PMCID: PMC10570911 DOI: 10.1001/jama.2023.21083] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
Importance To date, only 1 statewide prevalence survey has been performed for Acinetobacter baumannii (2009) in the US, and no statewide prevalence survey has been performed for Candida auris, making the current burden of these emerging pathogens unknown. Objective To determine the prevalence of A baumannii and C auris among patients receiving mechanical ventilation in Maryland. Design, Setting, and Participants The Maryland Multi-Drug Resistant Organism Prevention Collaborative performed a statewide cross-sectional point prevalence of patients receiving mechanical ventilation admitted to acute care hospitals (n = 33) and long-term care facilities (n = 18) between March 7, 2023, and June 8, 2023. Surveillance cultures (sputum, perianal, arm/leg, and axilla/groin) were obtained from all patients receiving mechanical ventilation. Sputum, perianal, and arm/leg cultures were tested for A baumannii and antibiotic susceptibility testing was performed. Axilla/groin cultures were tested by polymerase chain reaction for C auris. Main Outcomes and Measures Prevalence of A baumannii, carbapenem-resistant A baumannii (CRAB), and C auris. Prevalence was stratified by type of facility. Results All 51 eligible health care facilities (100%) participated in the survey. A total of 482 patients receiving mechanical ventilation were screened for A baumannii and 470 were screened for C auris. Among the 482 patients who had samples collected, 30.7% (148/482) grew A baumannii, 88 of the 148 (59.5%) of these A baumannii were CRAB, and C auris was identified in 31 of 470 (6.6%). Patients in long-term care facilities were more likely to be colonized with A baumannii (relative risk [RR], 7.66 [95% CI, 5.11-11.50], P < .001), CRAB (RR, 5.48 [95% CI, 3.38-8.91], P < .001), and C auris (RR, 1.97 [95% CI, 0.99-3.92], P = .05) compared with patients in acute care hospitals. Nine patients (29.0%) with cultures positive for C auris were previously unreported to the Maryland Department of Health. Conclusions A baumannii, carbapenem-resistant A baumannii, and C auris were common among patients receiving mechanical ventilation in both acute care hospitals and long-term care facilities. Both pathogens were significantly more common in long-term care facilities than in acute care hospitals. Patients receiving mechanical ventilation in long-term care facilities are a high-risk population for emerging pathogens, and surveillance and prevention efforts should be targeted to these facilities.
Collapse
Affiliation(s)
| | - Lisa Pineles
- University of Maryland School of Medicine, Baltimore
| | | | | | | | - Indira French
- University of Maryland School of Medicine, Baltimore
| | | | | | | | - Liore Klein
- Maryland Department of Health Laboratories Administration, Baltimore
| | - John Thoguru
- Maryland Department of Health Laboratories Administration, Baltimore
| | | | | |
Collapse
|
9
|
da Silva MEP, Gomes MADS, Rodrigues RS, Lima NCDS, Carvalho AG, Taborda RLM, Matos NB. Multidrug-resistant Acinetobacter spp. from hospital intensive care units in Brazilian Amazon. Braz J Infect Dis 2023; 27:103687. [PMID: 37977198 PMCID: PMC10667742 DOI: 10.1016/j.bjid.2023.103687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/19/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
Acinetobacter spp. are one of the main pathogens responsible for healthcare-associated infections and are associated with high rates of morbidity and mortality globally, mainly because of their high capacity to present and develop resistance to antimicrobials. To identify species of the Acinetobacter and their resistance profiles from samples collected from hospitalized patients, health professionals and hospital environmental sources in the intensive care units of different public reference hospitals in Porto Velho City, Rondônia, Western Brazilian Amazon. Isolates were identified using microbiological and molecular techniques. The antimicrobial susceptibility profile was determined by disk diffusion. A total of 201 Acinetobacter spp. isolates were identified, of which 47.3% originated from hospital structures, 46.8% from patients and 6% from healthcare professionals. A. baumannii and A. nosocomialis were the most prevalent, with frequency of 58.7% and 31.8%, respectively. Regarding the susceptibility profile, it was observed that 56.3% were classified as multidrug-resistant and 76.2% of the samples belonging to A. baumannii were resistant to carbapenems. In contrast, 96.9% were susceptible to polymyxin B and 91.3% to doxycycline. The data presented here can be used to guide and strengthen the control of multidrug-resistant infections caused by Acinetobacter spp., in addition to improving providing information from a traditionally unassisted region of Brazil.
Collapse
Affiliation(s)
- Marcos Eduardo Passos da Silva
- Fundação Oswaldo Cruz (FIOCRUZ/RO), Laboratório de Microbiologia, Porto Velho, RO, Brazil; Universidade Federal de Rondônia (UNIR), Porto Velho, RO, Brazil; Programa de Pós-Graduação em Biologia Experimental, Porto Velho, RO, Brazil
| | | | - Renata Santos Rodrigues
- Instituto Oswaldo Cruz (IOC), Programa de Pós-graduação em Biologia Celular e Molecular (PGBCM), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Nucia Cristiane da Silva Lima
- Fundação Oswaldo Cruz (FIOCRUZ/RO), Laboratório de Microbiologia, Porto Velho, RO, Brazil; Centro de Pesquisa em Medicina Tropical de Rondônia (CEPEM), Porto Velho, RO, Brazil
| | - Anjo Gabriel Carvalho
- Fundação Oswaldo Cruz (FIOCRUZ/RO), Laboratório de Microbiologia, Porto Velho, RO, Brazil; Universidade Federal de Rondônia (UNIR), Porto Velho, RO, Brazil; Programa de Pós-Graduação em Biologia Experimental, Porto Velho, RO, Brazil
| | | | - Najla Benevides Matos
- Fundação Oswaldo Cruz (FIOCRUZ/RO), Laboratório de Microbiologia, Porto Velho, RO, Brazil; Universidade Federal de Rondônia (UNIR), Porto Velho, RO, Brazil; Programa de Pós-Graduação em Biologia Experimental, Porto Velho, RO, Brazil; Centro de Pesquisa em Medicina Tropical de Rondônia (CEPEM), Porto Velho, RO, Brazil; Instituto Nacional de Epidemiologia na Amazônia Ocidental (INCT-EPIAMO), Porto Velho, RO, Brazil.
| |
Collapse
|
10
|
Schechner V, Lerner AO, Temkin E, Carmeli Y. Carbapenem-resistant Acinetobacter baumannii load in patients and their environment: the importance of detecting carriers. Infect Control Hosp Epidemiol 2023; 44:1670-1672. [PMID: 36971237 DOI: 10.1017/ice.2023.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The environment surrounding 30 of 31 carriers of carbapenem-resistant Acinetobacter baumannii (CRAB) was contaminated by CRAB. The environmental CRAB loads were similar whether carriers were identified only by surveillance cultures (nonclinical carriers) or also had positive clinical cultures. Screening to detect and isolate nonclinical CRAB carriers may be important to prevent CRAB transmission.
Collapse
Affiliation(s)
- Vered Schechner
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Or Lerner
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Elizabeth Temkin
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Yehuda Carmeli
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
11
|
Righi E, Mutters NT, Guirao X, Del Toro MD, Eckmann C, Friedrich AW, Giannella M, Kluytmans J, Presterl E, Christaki E, Cross ELA, Visentin A, Sganga G, Tsioutis C, Tacconelli E. ESCMID/EUCIC clinical practice guidelines on perioperative antibiotic prophylaxis in patients colonized by multidrug-resistant Gram-negative bacteria before surgery. Clin Microbiol Infect 2022; 29:463-479. [PMID: 36566836 DOI: 10.1016/j.cmi.2022.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
SCOPE The aim of the guidelines is to provide recommendations on perioperative antibiotic prophylaxis (PAP) in adult inpatients who are carriers of multidrug-resistant Gram-negative bacteria (MDR-GNB) before surgery. METHODS These evidence-based guidelines were developed after a systematic review of published studies on PAP targeting the following MDR-GNB: extended-spectrum cephalosporin-resistant Enterobacterales, carbapenem-resistant Enterobacterales (CRE), aminoglycoside-resistant Enterobacterales, fluoroquinolone-resistant Enterobacterales, cotrimoxazole-resistant Stenotrophomonas maltophilia, carbapenem-resistant Acinetobacter baumannii (CRAB), extremely drug-resistant Pseudomonas aeruginosa, colistin-resistant Gram-negative bacteria, and pan-drug-resistant Gram-negative bacteria. The critical outcomes were the occurrence of surgical site infections (SSIs) caused by any bacteria and/or by the colonizing MDR-GNB, and SSI-attributable mortality. Important outcomes included the occurrence of any type of postsurgical infectious complication, all-cause mortality, and adverse events of PAP, including development of resistance to targeted (culture-based) PAP after surgery and incidence of Clostridioides difficile infections. The last search of all databases was performed until April 30, 2022. The level of evidence and strength of each recommendation were defined according to the Grading of Recommendations Assessment, Development and Evaluation approach. Consensus of a multidisciplinary expert panel was reached for the final list of recommendations. Antimicrobial stewardship considerations were included in the recommendation development. RECOMMENDATIONS The guideline panel reviewed the evidence, per bacteria, of the risk of SSIs in patients colonized with MDR-GNB before surgery and critically appraised the existing studies. Significant knowledge gaps were identified, and most questions were addressed by observational studies. Moderate to high risk of bias was identified in the retrieved studies, and the majority of the recommendations were supported by low level of evidence. The panel conditionally recommends rectal screening and targeted PAP for fluoroquinolone-resistant Enterobacterales before transrectal ultrasound-guided prostate biopsy and for extended-spectrum cephalosporin-resistant Enterobacterales in patients undergoing colorectal surgery and solid organ transplantation. Screening for CRE and CRAB is suggested before transplant surgery after assessment of the local epidemiology. Careful consideration of the laboratory workload and involvement of antimicrobial stewardship teams before implementing the screening procedures or performing changes in PAP are warranted. High-quality prospective studies to assess the impact of PAP among CRE and CRAB carriers performing high-risk surgeries are advocated. Future well-designed clinical trials should assess the effectiveness of targeted PAP, including the monitoring of MDR-GNB colonization through postoperative cultures using European Committee on Antimicrobial Susceptibility Testing clinical breakpoints.
Collapse
Affiliation(s)
- Elda Righi
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Nico T Mutters
- University Hospital Bonn, Institute for Hygiene and Public Health, Bonn, Germany
| | - Xavier Guirao
- Surgical Endocrine Unit, Department of General Surgery, Surgical Site Prevention Unit, Parc Tauli, Hospital Universitari Sabadell, Spain
| | - Maria Dolores Del Toro
- Division of Infectious Diseases and Microbiology, University Hospital Virgen Macarena, Seville, Spain; Department of Medicine, University of Sevilla. Biomedicine Institute of Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas, Spain
| | - Christian Eckmann
- Klinikum Hannoversch-Muenden, Academic Hospital of Goettingen University, Germany
| | - Alex W Friedrich
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, the Netherlands; Institute for European Prevention Networks in Infection Control, University Hospital Münster, Münster, Germany
| | - Maddalena Giannella
- Infectious Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Jan Kluytmans
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Eirini Christaki
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Elizabeth L A Cross
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Alessandro Visentin
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy; Division of Infectious Diseases, Department of Internal Medicine I, University of Tübingen, Tübingen, Germany.
| |
Collapse
|
12
|
Spielberger B, Pfeil J, Assaad K, von Both U, Janda A, Kitz C, Kobbe R, Kunze M, Lindert J, Ritz N, Trapp S, Hufnagel M. Infektiologische Versorgung minderjähriger Flüchtlinge am Beispiel der Ukraine. Monatsschr Kinderheilkd 2022; 170:1103-1112. [PMID: 36188233 PMCID: PMC9510227 DOI: 10.1007/s00112-022-01607-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Hintergrund Bis Anfang Juni 2022 sind ca. 300.000 Kinder und Jugendliche aus der Ukraine im deutschen Ausländerzentralregister registriert worden. Die vorliegenden Handlungsempfehlungen sollen die Grundlage für eine evidenzbasierte und zielgerichtete infektiologische Versorgung minderjähriger Flüchtlinge am Beispiel der Ukraine schaffen. Ziele Die Handlungsempfehlungen sollen medizinisches Personal in der Versorgung minderjähriger Flüchtlinge aus der Ukraine unterstützen, um 1. einen unvollständigen Impfschutz frühzeitig zu erkennen und zu vervollständigen; 2. übliche Infektionskrankheiten zu diagnostizieren und zu behandeln; 3. in Deutschland seltene Infektionskrankheiten frühzeitig zu erkennen und zu therapieren. Material und Methoden Die Handlungsempfehlungen wurden als durch die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) koordinierte Leitlinie der Stufe 1 verfasst und an die Situation Flucht aus der Ukraine angepasst. Die Empfehlungen wurden durch eine repräsentativ zusammengesetzte Expertengruppe der beteiligten Fachgesellschaften im informellen Konsens erarbeitet und final von den Vorständen der Fachgesellschaften offiziell verabschiedet. Ergebnisse Es werden Empfehlungen für den Umfang der Anamnese und der körperlichen Untersuchung minderjähriger Flüchtlinge, angepasst an die Situation Flucht aus der Ukraine, ausgesprochen. Für alle minderjährigen Flüchtlinge werden die Bestimmung eines Differenzialblutbilds sowie Untersuchungen auf Tuberkulose, Hepatitis B und C sowie eine Human-Immunodeficiency-Virus(HIV)-Infektion empfohlen. Zur raschen Vervollständigung des Impfstatus wird eine alters- und Indikationsbezogene Priorisierung einzelner Impfungen vorgenommen. Diskussion Angesichts anhaltend hoher Flüchtlingszahlen nicht nur aus der Ukraine ist eine weitere Professionalisierung der medizinischen Versorgung minderjähriger Flüchtlinge notwendig. Hierzu sollten die notwendigen strukturellen und personellen Rahmenbedingungen geschaffen werden.
Collapse
Affiliation(s)
- B. Spielberger
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - J. Pfeil
- Praxis für Kinder- und Jugendmedizin, Schwaigern, Deutschland
| | - K. Assaad
- Gesundheitsamt Rhein-Neckar-Kreis, Heidelberg, Deutschland
| | - U. von Both
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, München, Deutschland
| | - A. Janda
- Universitätsklinik für Kinder- und Jugendmedizin, Ulm, Deutschland
| | - C. Kitz
- Praxis für Kinder- und Jugendmedizin, Veitshöchheim, Deutschland
| | - R. Kobbe
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M. Kunze
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - J. Lindert
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - N. Ritz
- Kinderspital, Luzerner Kantonsspital, Luzern, Schweiz
| | - S. Trapp
- Praxis für Kinder- und Jugendmedizin, Bremen, Deutschland
| | - M. Hufnagel
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| |
Collapse
|
13
|
Gastrointestinal Colonization of Carbapenem-Resistant Acinetobacter baumannii: What Is the Implication for Infection Control? Antibiotics (Basel) 2022; 11:antibiotics11101297. [PMID: 36289955 PMCID: PMC9598245 DOI: 10.3390/antibiotics11101297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 12/02/2022] Open
Abstract
The epidemiology of patients with gastrointestinal colonization of carbapenem-resistant Acinetobacter baumannii (CRAB) has not been systematically analyzed. We aimed to analyze the incidence, risk factors, and clinical outcomes of patients with newly identified gastrointestinal colonization of CRAB in a healthcare region in Hong Kong, where a multi-pronged screening strategy for gastrointestinal colonization of CRAB, together with other multidrug-resistant organisms (MDROs), was conducted by collecting fecal specimens (rectal swab or stool) upon admission and during hospitalization. From 1 October 2015 to 31 December 2019, a total of 161,339 fecal specimens from 63,588 patients, 61,856 (97.3%) of whom were hospitalized patients, and 54,525 (88.1%) were screened upon admission, with 1309 positive for CRAB (2.4% prevalence). Among patients positive for CRAB in fecal specimens, 698 (53.3%) had newly detected gastrointestinal colonization of CRAB, giving an incidence of 10.03 per 10,000 patient admissions and constituting 2646 CRAB colonization days in the general wards. Excluding the 164 patients with co-colonization of other MDROs, 534 patients had gastrointestinal colonization with only CRAB, and 12.5% (67/534) developed symptomatic CRAB infections at a median of 61 days (range: 2 to 671 days), during prospective follow-up for 2 years. Compared with age- and sex-matched controls, patients being referred from residential care homes for the elderly, the presence of indwelling devices, use of beta-lactam/beta-lactamase inhibitors, carbapenems, and proton pump inhibitors in the preceding 6 months, and history of hospitalization in the past 6 months were significantly associated with gastrointestinal colonization with CRAB, as shown by multivariable analysis. Log-rank test showed that cases had significantly shorter survival duration than controls (p < 0.001). The adjusted hazard ratio of gastrointestinal colonization of CRAB was 1.8 (95% CI: 1.5−2.2; p < 0.001), as shown by Cox regression analysis. Whole-genome sequencing of eight patients with CRAB isolates in their blood cultures and rectal swabs during the same episode of hospitalization revealed ST-195 as the predominant type, as shown by multilocus sequencing type. Gastrointestinal colonization of CRAB poses a considerable challenge for infection prevention and control.
Collapse
|
14
|
Pfeil J, Assaad K, von Both U, Janda A, Kitz C, Kobbe R, Kunze M, Lindert J, Ritz N, Trapp S, Hufnagel M. [Updated recommendations on the treatment of infectious diseases in refugees in childhood and adolescence in Germany (situation as of 30 March 2022), registered as S1 guidelines (AWMF-Register Nr. 048-017)]. Monatsschr Kinderheilkd 2022; 170:632-647. [PMID: 35645410 PMCID: PMC9130691 DOI: 10.1007/s00112-022-01499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/08/2022]
Abstract
Background Based on 190,000 applications for asylum, Germany remains a top destination for refugees and asylum seekers in Europe. The updated recommendations are considered evidence-based and targeted guidelines for the diagnosis and prevention of infectious diseases in underage refugees and asylum seekers. Objective The objective of these recommendations is to guide medical staff in the care of minor refugees, in particular to:1. assure early recognition and completion of incomplete vaccination status,2. diagnose and treat common infectious diseases,3. recognize and treat imported infectious diseases that are considered uncommon to the German healthcare system. Material and methods The recommendations have been formally written to be published as AWMF S1 guidelines.This includes a representative expert panel appointed by several professional societies, and formal adoption of the recommendations by the board of directors of all societies concerned. Results Recommendations are given for the medical evaluation of minor refugees, including medical history and physical examination. A blood count as well as screening for tuberculosis and hepatitis B should be offered to all minor refugees. In addition, screening for other infectious diseases like hepatitis C, HIV or schistosomiasis should be considered depending on age and country of origin. Vaccinations are recommended based on both age and country of origin. Conclusion As thousands of minor refugees continue to seek shelter in Germany every year, professional health care with adequate financial support needs to be established to ensure an appropriate medical treatment of this particularly vulnerable population.
Collapse
Affiliation(s)
- Johannes Pfeil
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
| | - Kholoud Assaad
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
| | - BVÖGD
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - Ulrich von Both
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
| | - DAKJ/Bündnis Kinder- und Jugendgesundheit
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - Aleš Janda
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
| | - Christa Kitz
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
| | - Robin Kobbe
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
| | - GTP
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - Mirjam Kunze
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
| | - DGGG
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - Judith Lindert
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
| | - DGKCH
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - Nicole Ritz
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
| | - PIGS
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - Stefan Trapp
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
| | - Markus Hufnagel
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - DGKJ
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| |
Collapse
|
15
|
Containment of a carbapenem-resistant Acinetobacter baumannii complex outbreak in a COVID-19 intensive care unit. Am J Infect Control 2022; 50:477-481. [PMID: 35227793 PMCID: PMC8881223 DOI: 10.1016/j.ajic.2022.02.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 01/10/2023]
Abstract
Background A carbapenem-resistant Acinetobacter baumannii outbreak in the COVID intensive care unit of a community hospital was contained using multidrug resistant organism guidelines. The purpose of this study is to report on an outbreak investigation and containment strategy that was used, and to discuss prevention strategy. Methods A multidisciplinary approach contained the spread of infection. Strategies implemented included consultation with experts, screening, and reversal of personal protective equipment conservation. Ensuring infection control best practices are maintained remain important efforts to reduce the spread of multidrug resistant organisms. Results Five patients with carbapenem-resistant Acinetobacter baumannii were identified from routine clinical cultures within one week and one patient was identified from active surveillance cultures. Discussion Personal protective equipment conservation, strategies to prevent health care personnel exposure, and patient surge staffing protocols may have increased the likelihood of multidrug resistant organism transmission. Environmental and behavioral infection control regulations with effective administrative guidance, active surveillance cultures, and antimicrobial stewardship are critical to prevent future outbreaks. Conclusions After outbreak containment strategies were implemented, no additional patients were identified with carbapenem-resistant Acinetobacter baumannii. Conventional infection prevention and control strategies were re-instituted. A multidisciplinary approach with continued focus on hand hygiene, environmental cleaning, and correct use of personal protective equipment needs to be put in place to successfully contain and prevent the spread of carbapenem resistant infections.
Collapse
|
16
|
Chan JL, Nazarian E, Musser KA, Snavely EA, Fung M, Doernberg SB, Pouch SM, Leekha S, Anesi JA, Kodiyanplakkal RP, Turbett SE, Walters MS, Epstein L. Prevalence of carbapenemase-producing organisms among hospitalized solid organ transplant recipients, five US hospitals, 2019-2020. Transpl Infect Dis 2022; 24:e13785. [PMID: 34989092 PMCID: PMC11318107 DOI: 10.1111/tid.13785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Passive reporting to the Centers for Disease Control and Prevention has identified carbapenemase-producing organisms (CPOs) among solid organ transplant (SOT) recipients, potentially representing an emerging source of spread. We analyzed CPO prevalence in wards where SOT recipients receive inpatient care to inform public health action to prevent transmission. METHODS From September 2019 to June 2020, five US hospitals conducted consecutive point prevalence surveys (PPS) of all consenting patients admitted to transplant units, regardless of transplant status. We used the Cepheid Xpert Carba-R assay to identify carbapenemase genes (blaKPC , blaNDM , blaVIM , blaIMP , blaOXA-48 ) from rectal swabs. Laboratory-developed molecular tests were used to retrospectively test for a wider range of blaIMP and blaOXA variants. RESULTS In total, 154 patients were screened and 92 (60%) were SOT recipients. CPOs were detected among 7 (8%) SOT recipients, from two of five screened hospitals: four blaKPC , one blaNDM , and two blaOXA-23 . CPOs were detected in two (3%) of 62 non-transplant patients. In three of five participating hospitals, CPOs were not identified among any patients admitted to transplant units. CONCLUSIONS Longitudinal surveillance in transplant units, as well as PPS in areas with diverse CPO epidemiology, may inform the utility of routine screening in SOT units to prevent the spread of CPOs.
Collapse
Affiliation(s)
- June L. Chan
- Wadsworth Center, New York State Department of Health, Albany, NY
| | | | | | - Emily A. Snavely
- Wadsworth Center, New York State Department of Health, Albany, NY
| | - Monica Fung
- University of California San Francisco, San Francisco, CA
| | | | | | - Surbhi Leekha
- University of Maryland Medical Center, Baltimore, MD
| | | | | | | | | | | |
Collapse
|
17
|
Duman Y, Ersoy Y, Tanriverdi ES, Otlu B, Toplu SA, Gözükara Bağ HG, Tekerekoglu MS, Bulam N, Canturk EK, Parmaksiz N. Oral colonization of Acinetobacter baumannii in intensive care units: Risk factors, incidence, molecular epidemiology, association with the occur of pneumonia and sepsis, and infection control measures. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2022; 25:239-244. [PMID: 35655587 PMCID: PMC9124532 DOI: 10.22038/ijbms.2022.59713.13243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/11/2022] [Indexed: 11/06/2022]
Abstract
Objectives Oral colonization of Acinetobacter baumannii can lead to infections such as pneumonia and sepsis. We aimed to evaluate oral colonization of hospitalized patients in ICUs and to examine risk factors for oral colonization, molecular epidemiology, and incidence of pneumonia and sepsis. Materials and Methods The study began in February 2021. Oral cultures were taken. The microorganisms were identified by a Maldi-tof MS mass spectrometry device. Colistin resistance genes were investigated by polymerase chain reaction. Clonal relationships were determined by pulsed-field gel electrophoresis. Results A. baumannii was found in 21 of 96 patients' oral cultures. Pneumonia and sepsis due to A. baumannii were detected in 14 and 5 patients, respectively. The mean growth time of A. baumannii from oral cultures was 11.8 days, and the meantime for the occurrence of pneumonia after oral growth was 5.2 days. We determined a plasmid mediated mcr-2 colistin resistance gene in a colistin susceptible A. baumannii strain. It is the first report of the plasmid mediated mcr-2 colistin resistance gene in our country. In total, fourteen different A. baumannii genotypes were determined in PFGE. It was determined that the effects of antibiotic use, oral motor dysfunction, mechanical ventilation, intubation, orogastric tube use, and total parenteral nutrition intake on oral colonization were statistically significant. Conclusion Oral colonization of A. baumannii is a significant concern in ICUs. We believe that it is important to take oral cultures and follow the risk factors and take infection control measures to prevent oral colonization of resistant isolates in ICUs.
Collapse
Affiliation(s)
- Yucel Duman
- Medical Microbiology Department. Inonu University Medical Faculty, Malatya, Turkey
| | - Yasemin Ersoy
- Infection Disease Department. Inonu University Medical Faculty, Malatya, Turkey
| | | | - Barıs Otlu
- Medical Microbiology Department. Inonu University Medical Faculty, Malatya, Turkey
| | | | | | | | - Nazire Bulam
- Infection Control Committee, Turgut Ozal Medical Center, Malatya, Turkey
| | | | - Nalan Parmaksiz
- Infection Control Committee, Turgut Ozal Medical Center, Malatya, Turkey
| |
Collapse
|
18
|
Mills JP, Marchaim D. Multidrug-Resistant Gram-Negative Bacteria: Infection Prevention and Control Update. Infect Dis Clin North Am 2021; 35:969-994. [PMID: 34752228 DOI: 10.1016/j.idc.2021.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Multidrug-resistant gram-negative bacteria (MDR-GNB) pose one of the greatest challenges to health care today because of their propensity for human-to-human transmission and lack of therapeutic options. Containing the spread of MDR-GNB is challenging, and the application of multifaceted infection control bundles during an evolving outbreak makes it difficult to measure the relative impact of each measure. This article will review the utility of various infection control measures in containing the spread of various MDR-GNB and will provide the supporting evidence for these interventions.
Collapse
Affiliation(s)
- John P Mills
- Division of Infectious Diseases, University of Michigan Medical School, F4177 University Hospital South, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-5226, USA.
| | - Dror Marchaim
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Infectious Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| |
Collapse
|
19
|
Integrated genomic, epidemiologic investigation of Candida auris skin colonization in a skilled nursing facility. Nat Med 2021; 27:1401-1409. [PMID: 34155414 DOI: 10.1038/s41591-021-01383-w] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 05/05/2021] [Indexed: 02/06/2023]
Abstract
Candida auris is a fungal pathogen of high concern due to its ability to cause healthcare-associated infections and outbreaks, its resistance to antimicrobials and disinfectants and its persistence on human skin and in the inanimate environment. To inform surveillance and future mitigation strategies, we defined the extent of skin colonization and explored the microbiome associated with C. auris colonization. We collected swab specimens and clinical data at three times points between January and April 2019 from 57 residents (up to ten body sites each) of a ventilator-capable skilled nursing facility with endemic C. auris and routine chlorhexidine gluconate (CHG) bathing. Integrating microbial-genomic and epidemiologic data revealed occult C. auris colonization of multiple body sites not targeted commonly for screening. High concentrations of CHG were associated with suppression of C. auris growth but not with deleterious perturbation of commensal microbes. Modeling human mycobiome dynamics provided insight into underlying alterations to the skin fungal community as a possible modifiable risk factor for acquisition and persistence of C. auris. Failure to detect the extensive, disparate niches of C. auris colonization may reduce the effectiveness of infection-prevention measures that target colonized residents, highlighting the importance of universal strategies to reduce C. auris transmission.
Collapse
|
20
|
Gottesman T, Fedorowsky R, Yerushalmi R, Lellouche J, Nutman A. An outbreak of carbapenem-resistant Acinetobacter baumannii in a COVID-19 dedicated hospital. Infect Prev Pract 2021; 3:100113. [PMID: 34316574 PMCID: PMC7794049 DOI: 10.1016/j.infpip.2021.100113] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/03/2021] [Indexed: 01/09/2023] Open
Abstract
We describe an outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) in a COVID-19 dedicated hospital. The suspected mechanism of transfer was an environmental source that persisted despite evacuation and terminal cleaning of the entire hospital, and transmitted through healthcare workers' hands or equipment. This outbreak demonstrates that practices to prevent the spread of multidrug-resistant organisms must not be neglected during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Tamar Gottesman
- Infectious Diseases and Control Unit, Rabin Medical Center, Hasharon Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rina Fedorowsky
- Infectious Diseases and Control Unit, Rabin Medical Center, Hasharon Hospital, Petach Tikva, Israel
| | - Rebecca Yerushalmi
- Microbiology Laboratory, Rabin Medical Center, Hasharon Hospital, Petach Tikva, Israel
| | - Jonathan Lellouche
- National Institute for Infection Control and Antibiotic Resistance, Israel Ministry of Health, Israel
| | - Amir Nutman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Institute for Infection Control and Antibiotic Resistance, Israel Ministry of Health, Israel
| |
Collapse
|