High mortality in an outbreak of multidrug resistant Acinetobacter baumannii infection introduced to an oncological hospital by a patient transferred from a general hospital

Abstract

Objective To describe the clinical features, outcomes, and molecular epidemiology of an outbreak of multidrug resistant (MDR) A. baumannii. Methods We performed a retrospective analysis of all MDR A. baumannii isolates recovered during an outbreak from 2011 to 2015 in a tertiary care cancer hospital. Cases were classified as colonized or infected. We determined sequence types following the Bartual scheme and plasmid profiles. Results There were 106 strains of A. baumannii isolated during the study period. Sixty-six (62.3%) were considered as infection and 40 (37.7%) as colonization. The index case, identified by molecular epidemiology, was a patient with a drain transferred from a hospital outside Mexico City. Ninety-eight additional cases had the same MultiLocus Sequence Typing (MLST) 758, of which 94 also had the same plasmid profile, two had an extra plasmid, and two had a different plasmid. The remaining seven isolates belonged to different MLSTs. Fifty-three patients (50%) died within 30 days of A. baumanniii isolation: 28 (20%) in colonized and 45 (68.2%) in those classified as infection (p<0.001). In multivariate regression analysis, clinical infection and patients with hematologic neoplasm, predicted 30-day mortality. The molecular epidemiology of this outbreak showed the threat posed by the introduction of MDR strains from other institutions in a hospital of immunosuppressed patients and

Antibiotic resistance in the patient with cancer: Escalating challenges and paths forward

“…[59][60][61] In addition, patients with cancer are vulnerable to health care-acquired infections as a major source of antibioticresistant organisms. 32,62,63 We have summarized several studies in which ESKAPE pathogens were isolated from patients with cancer since 2015 in Table 2. 31,[59][60][61][62][64][65][66][67][68][69][70][71][72][73][74] These illustrate the prevalence of MDR in different ESKAPE pathogens and highlight that prior antibiotic exposure and hospital-acquired infections are the major risk factors for developing antibiotic resistance in patients with cancer.…”

“…32,62,63 We have summarized several studies in which ESKAPE pathogens were isolated from patients with cancer since 2015 in Table 2. 31,[59][60][61][62][64][65][66][67][68][69][70][71][72][73][74] These illustrate the prevalence of MDR in different ESKAPE pathogens and highlight that prior antibiotic exposure and hospital-acquired infections are the major risk factors for developing antibiotic resistance in patients with cancer. For Figure 1, we derived data from the National Healthcare Safety Network (NHSN) 2015 to 2017 adult and pediatric antibiotic resistance reports 75,76 to illustrate differences between the percentage of central line-associated bloodstream infections by ESKAPE pathogens that tested nonsusceptible to selected antimicrobial agents.…”

Bacterial Community and Genomic Analysis of Carbapenem-Resistant Acinetobacter baumannii Isolates from the Environment of a Health Care Facility in the Western Region of Saudi Arabia

“…Acinetobacter baumannii is certainly one of the most successful pathogens responsible for HAI in the modern healthcare system and with increasing reports of community-acquired infections [ 3 , 10 , 11 ]. The mortality rates from this pathogen range from 8% to 35%, depending on the type of infection and the duration of the hospital stay [ 12 ]. Most healthcare-associated infections caused by A. baumannii involve ventilator-associated pneumonia and bloodstream infections.…”

“…This bacterium has a remarkable capacity to survive on abiotic surfaces, from non-medical objects, such as door knobs, sinks, bed rails, and pillows, to medical equipment, such as ventilator circuits and catheters [ 3 , 15 , 16 ]. As a consequence, A. baumannii is transmitted through contact with inanimate objects, making it a constant threat to old, critically ill, and immunosuppressed patients [ 12 , 13 ].…”

Surveillance cultures following a regional outbreak of carbapenem-resistant Acinetobacter baumannii

“…(Received 8 January 2021; accepted 5 April 2021; electronically published 14 May 2021) According to the 2019 Centers for Disease Control and Prevention (CDC), 1 Acinetobacter baumannii has become an urgent threat in healthcare facilities in the United States, [2][3][4][5][6][7][8][9][10] with contaminated environment or contaminated healthcare workers hands playing a major role in the spread of this organism. [11][12][13][14] Facilities have implemented infection control measures, such as surveillance, to control its spread.…”