An Outbreak of Imipenem-Resistant<i>Acinetobacter baumannii</i>in Critically Ill Surgical Patients

Fierobe, Lisiane; Lucet, Jean‐Christophe; Decré, Dominique; Müller-Serieys, Claudette; Deleuze, Arnaud; Joly-Guillou, Marie-Laure; Mantz, Jean; Desmonts, Jean-Marie

doi:10.1086/501822

Cited by 91 publications

(55 citation statements)

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“…Multidrug-resistant patterns are common in A. baumannii nosocomial outbreaks (13,40). Susceptibility testing of the 58 epidemic PFGE types showed a widespread multidrug-resistant phenotype.…”

Section: Discussionmentioning

confidence: 99%

Clonal Diversity of Nosocomial Epidemic Acinetobacter baumannii Strains Isolated in Spain

et al. 2011

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Acinetobacter baumannii is one of the major pathogens involved in nosocomial outbreaks. The clonal diversity of 729 epidemic strains isolated from 19 Spanish hospitals (mainly from intensive care units) was analyzed over an 11-year period. Pulsed-field gel electrophoresis (PFGE) identified 58 PFGE types that were subjected to susceptibility testing, rpoB gene sequencing, and multilocus sequence typing (MLST). All PFGE types were multidrug resistant; colistin was the only agent to which all pathogens were susceptible. The 58 PFGE types were grouped into 16 clones based on their genetic similarity (cutoff of 80%). These clones were distributed into one major cluster (cluster D), three medium clusters (clusters A, B, and C), and three minor clusters (clusters E, F, and G). Multidrug-resistant Acinetobacter baumannii is a bacterium frequently endemic in certain hospital wards and is responsible for numerous nosocomial outbreaks around the world (3,23,33). Its great capacity to survive in low-moisture environments and its ability to develop resistance to antimicrobial agents afford A. baumannii the possibility of spreading in hospitals. The skin, oropharynx, and digestive tract are the main body areas colonized in hospitalized patients. The risk of colonization and subsequent infection are associated with factors such as the presence of underlying severe illnesses, long-term hospitalization, stays in specific hospital wards, selective antimicrobial pressure, and invasive interventions such as the use of mechanical ventilation or catheters (4,12,14,18).Nosocomial outbreaks of A. baumannii can have their origin in a single reservoir or in multiple contaminated sites (37, 39), and infection can have serious repercussions for patient morbidity and mortality. Patients can acquire the bacterium from an environmental source or from other patients (6, 18).The clonal study of hospital strains is very important in terms of an understanding of the epidemiology of these outbreaks. The aim of the present work was therefore to analyze the genetic diversity and clonal distribution of epidemic strains of A. baumannii isolated from around Spain over a long period of time. Isolates collected during outbreaks at different hospitals were analyzed by pulsed-field gel electrophoresis (PFGE), sequencing of the RNA polymerase ␤ subunit (rpoB) gene, and multilocus sequence typing (MLST). The results were then compared. Antimicrobial susceptibility testing was also performed to determine the multidrug resistance phenotypes of these epidemic strains. MATERIALS AND METHODSBacterial strains. Over the 11-year period from 1997 to 2007, an initial 814 A. baumannii strains isolated from clinical settings and suspected of being involved in nosocomial outbreaks were sent to the Spanish National Center for Microbiology (CNM) for typing. Strains were isolated from 19 public hospitals in 17 Spanish provinces. Hospitals were coded H1 to H19, and provinces were coded P1 to P17. The type of clinical sample, the hospital ward of origin, and the isolation per...

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Section: Discussionmentioning

confidence: 99%

Clonal Diversity of Nosocomial Epidemic Acinetobacter baumannii Strains Isolated in Spain

et al. 2011

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“…One of the main reasons is that clinical isolates are frequently resistant to many commonly used antimicrobial agents (multidrug resistant -MDR) [10,33]. Often are susceptible only to carbapenems (imipenem, meropenem), though resistant strains are increasingly reported, and amikacin, polymyxins, but some may be susceptible only to polymyxins [29,35,40,43,56,57,74,106,129,136]. Colonization of the digestive tract intensive care unit patients is an important epidemiologic reservoir for multi-drug resistant Acinetobacter baumannii infections in hospital outbreaks [22].…”

Section: Introduction -Acinetobacter Baumanniimentioning

confidence: 99%

Multidrug resistant Acinetobacter baumannii--the role of AdeABC (RND family) efflux pump in resistance to antibiotics.

Wieczorek

Sacha²,

Hauschild³

et al. 2008

Folia Histochem Cytobiol.

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Abstract:Acinetobacter baumannii is an opportunistic pathogen which play the more and more greater role in the pathogenicity of the human. It is often attached with the hospital environment, in which is able easily to survive for many days even in adverse conditions. Acinetobacter baumannii is the species responsible for a serious nosocomial infections, especially in the intensive care units. Option of surviving in natural niches, and in the hospital environment could also be associated with the efflux pump mechanisms. Mechanisms of efflux universally appear in all cells (eukaryotic and prokaryotic) and play the physiological important role. In prokaryote, the main functions are evasion of such naturally produced molecules, removal of metabolic products and toxins. These pumps could also be involved in an early stage of infection, such as adhesion to host cells and the colonization. Importantly, they remove commonly used antibiotics from the cell in therapy of infections caused by these bacteria. Efflux pumps exemplify a unique phenomenon in drug resistance: a single mechanism causing resistance against several different classes of antibiotics. In Acinetobacter baumannii, the AdeABC efflux pump, a member of the resistance-nodulation-cell division family (RND), has been well characterized. Aminoglicosides, tetracyclines, erythromycin, chloramphenicol, trimethoprim, fluoroquinolones, some β-lactams, and also recently tigecycline, were found to be substrates for this pump. Drugs, as substrates for the AdeABC pump, can increase the expression of the AdeABC genes, leading to multidrug resistance (MDR). From this reason, treatment failure and death caused by Acinetobacter baumannii infections or underlying diseases are common. Because the AdeABC pump is widespread in Acinetobacter baumannii, similarly to other pumps in Gram-negative and Gram-positive bacteria, exists a need of searching a new therapeutic solutions. Specific efflux inhibitors of pumps (EPIs), including AdeABC inhibitors, could be suppress the activity of pumps and restore the sensitivity of such important bacteria as Acinetobacter baumannii to commonly used antibiotic.

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“…NIHR Journals Library www.journalslibrary.nihr.ac.uk the changing epidemiology of HCAIs, 589,[607][608][609][610] exemplified by the rise of MRSA and extended-spectrum beta-lactamase (ESBL)-producing strains of Escherichia coli and Klebsiella pneumonia. 609,[611][612][613][614][615][616][617][618][619] In the NHS, following major outbreaks of hospital-acquired (nosocomial) infection, 620 national targets for the reduction of MRSA bacteremias (blood infections) and C. difficile (gastrointestinal) infection are supported by enhanced mandatory surveillance.…”

Section: Reducing Health-care-associated Infectionmentioning

confidence: 99%

“…[655][656][657][658][659][660] IPAC teams, therefore, have a central role to play in active staff engagement, 661 support for peer-to-peer education, 662 and the monitoring of HCAIs to reduce the burden of avoidable harm to patients and its associated untoward costs. 581, The changing epidemiology of HCAIs 607,608,611,612,617, also places demands on medical microbiologists and clinical pharmacists specialising in antibiotic medicines management. 57,671 Collectively, their active stewardship of antibiotic prescribing is acknowledged to limit overprescribing 672 and improve adherence to guidelines.…”

Section: Reducing Health-care-associated Infectionmentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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An Outbreak of Imipenem-ResistantAcinetobacter baumanniiin Critically Ill Surgical Patients

Abstract: The outbreak ended after strict application of control measures. Our results suggest that high work load contributes to IR-Ab acquisition.

Cited by 91 publications

References 43 publications

Clonal Diversity of Nosocomial Epidemic Acinetobacter baumannii Strains Isolated in Spain

Clonal Diversity of Nosocomial Epidemic Acinetobacter baumannii Strains Isolated in Spain

Multidrug resistant Acinetobacter baumannii--the role of AdeABC (RND family) efflux pump in resistance to antibiotics.

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

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