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.
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• 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.
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• Subjects:
  • Article
  • Acinetobacter Infections
  • Acinetobacter baumannii
  • Adult
  • Aged
  • Aged, 80 and over
  • Cross Infection
  • Disease Outbreaks
  • Drug Resistance, Multiple, Bacterial
  • Electrophoresis, Gel, Pulsed-Field
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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
• Download URL:
  https://stacks.cdc.gov/view/cdc/51159/cdc_51159_DS1.pdf
• File Type:
  [PDF - 457.83 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:794a0b436dbee18d6af83f783d10814f16c01122e02b6ea7c616f42d3723d90a