4/1/2014 Multiple intensive care unit outbreak of Acinetobac... [Am J Med. 1988] - PubMed - NCBI

http://www.ncbi.nlm.nih.gov/pubmed/3189366 1/2

PURPOSE:

PATIENTS AND METHODS:

RESULTS:

CONCLUSION:

Am J Med. 1988 Nov;85(5):624-31.

Multiple intensive care unit outbreak of Acinetobacter calcoaceticussubspecies anitratus respiratory infection and colonization associatedwith contaminated, reusable ventilator circuits and resuscitation bags.

Hartstein AI , Rashad AL, Liebler JM, Actis LA, Freeman J, Rourke JW Jr, Stibolt TB, Tolmasky ME, Ellis

GR, Crosa JH.

Abstract

Acinetobacter calcoaceticus subspecies anitratus (A. anitratus) can cause

nosocomially and community acquired pneumonia. Source identification of the organism is often

difficult. An outbreak of respiratory infection and colonization with A. anitratus affecting 93

ventilated patients in all six of a hospital's intensive care units (ICUs) over 10 months is described.

In April 1984, the infection control staff started to review positive

culture results from all patients in all ICUs. At this point, information on significant isolates was

recorded by patient, site, date, genus and species, and antimicrobial susceptibility. During the

month of August 1984, an increased number of A. anitratus isolates from sputum began to be

detected. Information was expanded to include the date of hospital admission, ICU admission,

intubation, and extubation; the dates and types of all surgical procedures; the results and dates of

all prior sputum cultures; and the use of nebulized bronchodilator medications. Monthly numbers of

cases were compared for four months prior to the outbreak, during the outbreak, and for seven

months after the outbreak. Plasmid DNA from isolates was prepared, electrophoresed, and

visualized. Isolates were designated according to the molecular weights of visualized plasmids.

Barrier precautions and improved staff handwashing did not diminish the frequency of

new cases. When pasteurized, reusable ventilator circuits and resuscitation bags were cultured for

the possibility of low-level contamination, 18 percent were positive for A. anitratus. Terminal

ethylene oxide sterilization of these devices was associated with prompt control of the outbreak.

Plasmid DNA analysis of isolates from patients involved in the outbreak, contaminated devices,

and the hands of personnel responsible for device disinfection revealed two predominant plasmid

profiles. After outbreak control, isolates with these profiles were found much less frequently in

patient specimens.

Contaminated, reusable ventilator support equipment may be a leading cause

for the extent of A. anitratus in the sputum of intubated patients. This problem is potentially

correctable by the use of terminal etyhlene oxide sterilization of reusable ventilator circuits and

resuscitation bags.

PMID: 3189366 [PubMed - indexed for MEDLINE]

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4/1/2014 Multiple intensive care unit outbreak of Acinetobac... [Am J Med. 1988] - PubMed - NCBI

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