Epidemiology of multiple Acinetobacter outbreaks in The Netherlands during the period 1999–2001

Abstract

An increase in the number of outbreaks of Acinetobacter infection was notified in The Netherlands during 1999-2001. The present study compared the outbreaks at the species and strain levels, and analysed the epidemiology and control measures at the different locations. For each institute, three representative isolates from three patients were identified to the species and strain levels by genotyping methods. A questionnaire investigated the impact of the outbreak, the control measures that were taken, and the possible effects of the measures. Seven outbreaks were associated with Acinetobacter baumannii (three outbreaks with a strain designated strain A, two outbreaks with a strain designated strain B, and one outbreak each with strains designated C and D). An additional outbreak was caused by genomic species 13TU, which is related closely to A. baumannii. Strains B and D were identified as European clones III and II, respectively. Except for two hospitals with outbreaks caused by strain A, there was no known epidemiological link between the participating hospitals. In all hospitals the outbreak occurred on one or several intensive care units, and spread to other departments was noted in two hospitals. The number of patients affected ranged from six to 66 over a period of 2-22 months. In most outbreaks, patients were the likely reservoir from which spread occurred. In all hospitals, a large panel of measures was required to bring the outbreak to an end. Extensive environmental sampling yielded numerous positive samples in most but not all hospitals.

Burn unit: colonization of burn wounds and local environment

“…Those strains can be found in various sites in the patient's environment, including bed curtains, furniture and hospital equipment. [13] This bacteria can be spread through the air over short distances in water droplets and in the scales of the skin of patients who are colonized, [14] but the most common mode of transmission is from the hands of hospital staff. Patients who are colonized or infected by A. baumannii can carry this strain at different body sites for periods of days to weeks.…”

<i>Acinetobacter</i> multirresistente – um desafio para a saúde pública

“…Uma das principais características desse microrganismo é sua capacidade de sobreviver em superfícies inanimadas, mesmo na ausência de umidade, por longos períodos de tempo. 5,15,22 O ambiente ao redor do leito do paciente parece ser a fonte ambiental mais importante de transmissão do microrganismo. A contaminação do ambiente hospitalar e a transmissão entre pacientes mediada pelos profissionais de saúde e pelos equipamentos médicos têm um papel importantíssimo.…”

“…A contaminação do ambiente hospitalar e a transmissão entre pacientes mediada pelos profissionais de saúde e pelos equipamentos médicos têm um papel importantíssimo. 5,6,10,22 Os surtos de CRAb podem ocorrer em diferentes unidades hospitalares, como unidades de internação clínica, de internação cirúrgica, de politraumatizados, UTI neonatal, UTI pediátrica e UTI de adultos. No entanto, a maior parte dos relatos de surto ocorre em UTI de adultos, em pacientes com mais de 50 anos.…”

“…No entanto, a maior parte dos relatos de surto ocorre em UTI de adultos, em pacientes com mais de 50 anos. 19,22,23 Alguns estudos relatam que determinadas cepas epidêmicas de CRAb têm sido isoladas de swab da pele e swab retal de pacientes, durante períodos de surto. 24,25 Esse fato relaciona a importância da colonização de pacientes hospitalizados com a disseminação do microrganismo.…”

“…Entretanto, quando relatamos surtos mais amplos, com disseminação entre hospitais de uma mesma cidade ou país, a disseminação está associada a um determinante de resistência que se propaga entre diferentes cepas. 22,25,[28][29][30]32,35,37,44 …”