Failure to Communicate: Transmission of Extensively Drug-Resistant blaOXA-237-Containing Acinetobacter baumannii—Multiple Facilities in Oregon, 2012–2014

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Buser, Genevieve L. ; Cassidy, P. Maureen ; Cunningham, Margaret C. ; Rudin, Susan ; Hujer, Andrea M. ; Vega, Robert ; Furuno, Jon P. ; Marshall, Steven H. ; Higgins, Paul G. ; Jacobs, Michael R. ; Wright, Meredith S. ; Adams, Mark D. ; Bonomo, Robert A. ; Pfeiffer, Christopher D. ; Beldavs, Zintars G.
• Description:
  OBJECTIVE
  
  To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii.
  
  DESIGN
  
  Outbreak investigation.
  
  SETTING AND PARTICIPANTS
  
  Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals.
  
  METHODS
  
  A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed.
  
  RESULTS
  
  We identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n = 8), or skilled nursing facility A (n = 8), or both (n = 1) prior to XDR A. baumannii isolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase gene blaOXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission.
  
  CONCLUSIONS
  
  Interfacility transmission of XDR A. baumannii carrying the rare blaOXA-237 was facilitated by transfer of affected patients without communication to receiving facilities.
  
  
• Subjects:
  Acinetobacter Baumannii Acinetobacter Infections Adult Aged Aged, 80 And Over Article Cross Infection Disease Outbreaks Drug Resistance, Multiple, Bacterial Electrophoresis, Gel, Pulsed-Field Female Humans Male Middle Aged Multilocus Sequence Typing Oregon Polymerase Chain Reaction

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• Source:
  Infect Control Hosp Epidemiol. 38(11):1335-1341
• Pubmed ID:
  28870269
• Pubmed Central ID:
  PMC5783543
• Document Type:
  Journal Article
• Funding:
  R01 AI100560/AI/NIAID NIH HHSUnited States/ ; R01 AI072219/AI/NIAID NIH HHSUnited States/ ; R01 AI063517/AI/NIAID NIH HHSUnited States/ ; U19 AI110819/AI/NIAID NIH HHSUnited States/ ; I01 BX001974/BX/BLRD VAUnited States/ ; U54CK000484/ACL HHSUnited States/ ; U54 CK000484/CK/NCEZID CDC HHSUnited States/
• Volume:
  38
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:794a0b436dbee18d6af83f783d10814f16c01122e02b6ea7c616f42d3723d90a
• Download URL:
  https://stacks.cdc.gov/view/cdc/51159/cdc_51159_DS1.pdf
• File Type:
  [PDF - 457.83 KB ]