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BACKGROUND:

METHODS:

RESULTS:

CONCLUSION:

Surg Infect (Larchmt).2001 Winter;2(4):297-301.

Eradication of multi-drug resistant Acinetobacter from an intensive careunit.

Podnos YD , Cinat ME, Wilson SE, Cooke J, Gornick W, Thrupp LD.

Abstract

Acinetobacter baumannii is a gram-negative coccobacillus that causes

outbreaks of nosocomial infections in ICUs. Due to resistance to multiple antibiotics, management

of clusters of A. baumannii is useful as a model in eradication of multi-drug resistant infections.We outline the evolution of an A. baumannii outbreak, focusing on methods of transmission and

multidisciplinary measures aimed at eliminating it from the ICU.

Patients in an urban, tertiary care medical center from November 1996 to December

1997 having positive cultures for multi-drug resistant A. baumannii are included in this study. A.

baumannii was isolated on blood agar and MacConkey cultures and identified by Vitek panel.

Disk diffusion including amikacin, imipenem, polymyxin B, and sulbactam were used to determine

resistance.

An outbreak of 52 patients (27 infected, 25 colonized) with 68 positive sites beganwith the transfer of a colonized >50% total body surface area burn patient from an outside hospital.

Within 3 days, the index patient was in the burn ICU, coronary care unit, and medical ICU. Soon,

clusters of patients with A. baumannii infections sensitive only to polymyxin B were seen in those

units and, ultimately, the surgical ICU. On typing, 2 strains were found, PFGE B and C. Given the

level of antibiotic resistance, patients with colonization or infection were cohorted and placed on

contact isolation. Strict antiseptic measures, such as hand-washing, barrier isolation, equipment

and room cleaning, sterilization of ventilator equipment, and dedication of medical equipment to

each patient were instituted. Still, positive environmental cultures were found in ventilator water

traps, sinks, and bedrails. Sporadic cases continued for a total of 13 months, with 10 deaths

resulting from the infections.

A. baumannii is a mildly virulent organism that becomes resistant to

antimicrobials. Because of multiple antibiotic resistance, strict contact isolation cohorting and

antiseptic technique are the primary modes of containment. This outbreak serves as a model of

eradication of multi-drug resistant organisms from ICUs. These measures will become of greater

importance as nosocomial organisms develop increasing resistance to antimicrobials.

Comment inInfection control is a matter of self control. [Surg Infect (Larchmt). 2001]

PMID: 12593705 [PubMed - indexed for MEDLINE]

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http://www.ncbi.nlm.nih.gov/pubmed?term=Podnos%20YD%5BAuthor%5D&cauthor=true&cauthor_uid=12593705http://www.ncbi.nlm.nih.gov/pubmed?term=Cinat%20ME%5BAuthor%5D&cauthor=true&cauthor_uid=12593705http://www.ncbi.nlm.nih.gov/pubmed?term=Wilson%20SE%5BAuthor%5D&cauthor=true&cauthor_uid=12593705http://www.ncbi.nlm.nih.gov/pubmed?term=Cooke%20J%5BAuthor%5D&cauthor=true&cauthor_uid=12593705http://www.ncbi.nlm.nih.gov/pubmed?term=Gornick%20W%5BAuthor%5D&cauthor=true&cauthor_uid=12593705http://www.ncbi.nlm.nih.gov/pubmed?term=Thrupp%20LD%5BAuthor%5D&cauthor=true&cauthor_uid=12593705http://www.ncbi.nlm.nih.gov/pubmed/12593700http://www.ncbi.nlm.nih.gov/pubmed/12593700http://dx.doi.org/10.1089/10962960152813331http://www.ncbi.nlm.nih.gov/pubmed/12593700http://www.ncbi.nlm.nih.gov/pubmed?term=Thrupp%20LD%5BAuthor%5D&cauthor=true&cauthor_uid=12593705http://www.ncbi.nlm.nih.gov/pubmed?term=Gornick%20W%5BAuthor%5D&cauthor=true&cauthor_uid=12593705http://www.ncbi.nlm.nih.gov/pubmed?term=Cooke%20J%5BAuthor%5D&cauthor=true&cauthor_uid=12593705http://www.ncbi.nlm.nih.gov/pubmed?term=Wilson%20SE%5BAuthor%5D&cauthor=true&cauthor_uid=12593705http://www.ncbi.nlm.nih.gov/pubmed?term=Cinat%20ME%5BAuthor%5D&cauthor=true&cauthor_uid=12593705http://www.ncbi.nlm.nih.gov/pubmed?term=Podnos%20YD%5BAuthor%5D&cauthor=true&cauthor_uid=12593705

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4/1/2014 Eradication of multi-drug resistant Ac... [Surg Infect (Larchmt). 2001] - PubMed - NCBI

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