Multidrug-Resistant<i>Acinetobacter baumannii</i>Infection, Colonization, and Transmission Related to a Long-Term Care Facility Providing Subacute Care

Mortensen, Eva; Trivedi, Kavita K.; Rosenberg, Jon; Cody, Sara H.; Long, Janet B.; Jensen, Bette; Vugia, Duc J.

doi:10.1086/675612

Cited by 36 publications

(37 citation statements)

References 25 publications

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“…24–26 In a study of a single NH also providing subacute care, 20% of residents surveyed were colonized with A. baumannii ; among these isolates, most were MDR and a third were carbapenem resistant. 26 Our study focusing on high-risk patients from 4 NH facilities shows similar rates of colonization and increased rates of drug resistance, including 70% resistance to carbapenems among isolates.…”

Section: Disscussionmentioning

confidence: 99%

Prevalence of and Risk Factors for Multidrug-ResistantAcinetobacter baumanniiColonization Among High-Risk Nursing Home Residents

Mody

Gibson

Horcher

et al. 2015

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To characterize the epidemiology of multidrug-resistant (MDR) Acinetobacter baumannii colonization in high-risk nursing home (NH) residents. DESIGN Nested case-control study within a multicenter prospective intervention trial. SETTING Four NHs in Southeast Michigan. PARTICIPANTS Case patients and control subjects were NH residents with an indwelling device (urinary catheter and/or feeding tube) selected from the control arm of the Targeted Infection Prevention study. Cases were residents colonized with MDR (resistant to ≥3 classes of antibiotics) A. baumannii; controls were never colonized with MDR A. baumannii. METHODS For active surveillance cultures, specimens from the nares, oropharynx, groin, perianal area, wounds, and device insertion site(s) were collected upon study enrollment, day 14, and monthly thereafter. A. baumannii strains and their susceptibilities were identified using standard microbiologic methods. RESULTS Of 168 NH residents, 25 (15%) were colonized with MDR A. baumannii. Compared with the 143 controls, cases were more functionally disabled (Physical Self-Maintenance Score >24; odds ratio, 5.1 [95% CI, 1.8–14.9]; P < .004), colonized with Proteus mirabilis (5.8 [1.9–17.9]; P < .003), and diabetic (3.4 [1.2–9.9]; P < .03). Most cases (22 [88%]) were colonized with multiple antibiotic-resistant organisms and 16 (64%) exhibited co-colonization with at least one other resistant gram-negative bacteria. CONCLUSION Functional disability, P. mirabilis colonization, and diabetes mellitus are important risk factors for colonization with MDR A. baumannii in high-risk NH residents. A. baumannii exhibits widespread antibiotic resistance and a preference to colonize with other antibiotic-resistant organisms, meriting enhanced attention and improved infection control practices in these residents.

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Section: Disscussionmentioning

confidence: 99%

Prevalence of and Risk Factors for Multidrug-ResistantAcinetobacter baumanniiColonization Among High-Risk Nursing Home Residents

Mody

Gibson

Horcher

et al. 2015

Infect. Control Hosp. Epidemiol.

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“…5,10,14 These characteristics favor both a heavy bioburden of colonizing bacteria and a need for more frequent healthcare contact, thereby increasing the likelihood of transmission via healthcare worker hands or fomites to other patients. Infection control deficiencies, (eg, improper bronchoscope reprocessing or inadequate hand washing) in the long-term-care chronic- and acute-care settings may have amplified transmission within the facilities.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Clear, timely, and complete communication of patient infection or colonization by organisms of public health significance that have potential for person-to-person transmission (eg, multidrug-resistant organisms [MDROs], Clostridium difficile , norovirus, influenza, Mycobacterium tuberculosis ) can prevent transmission between healthcare facilities. 11–14 We investigated an outbreak of XDR A. baumannii infections in Oregon—where the pathogen had been rare—in an effort to prevent it from establishing endemicity.…”

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confidence: 99%

Failure to Communicate: Transmission of Extensively Drug-Resistantbla_OXA-237-ContainingAcinetobacter baumannii—Multiple Facilities in Oregon, 2012–2014

Buser

Cassidy

Cunningham

et al. 2017

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii. DESIGN Outbreak investigation. SETTING AND PARTICIPANTS Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals. METHODS A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed. RESULTS We identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n = 8), or skilled nursing facility A (n = 8), or both (n = 1) prior to XDR A. baumannii isolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase gene blaOXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission. CONCLUSIONS Interfacility transmission of XDR A. baumannii carrying the rare blaOXA-237 was facilitated by transfer of affected patients without communication to receiving facilities.

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“…In addition, several studies documented that A. baumannii also occurs in patients in LTCFs [3, 7, 8]. In Maryland Thom and colleagues investigated the colonization of patients by A. baumannii in LTCFs providing care to mechanically ventilated patients [15].…”

Section: Discussionmentioning

confidence: 99%

Colonization of long term care facility patients with MDR-Gram-negatives during an Acinetobacter baumannii outbreak

Zollner‐Schwetz

Zechner

Ullrich

et al. 2017

Antimicrob Resist Infect Control

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BackgroundWe aimed to determine the prevalence of colonization by multidrug-resistant Gram-negative bacteria including ESBL-producing enterobacteriaceae, carbapenem-resistant enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii at two wards caring long term for patients with disorder of consciousness at the Geriatric Health Centers Graz, Austria. During our study we detected two A. baumannii outbreaks.MethodsIn August 2015, we conducted a point-prevalence study. Inguinal and perianal swabs were taken from 38 patients and screened for multidrug-resistant Gram-negative rods using standard procedures. Six months after the initial investigation all patients were sampled again and use of antibiotics during the past 6 months and mortality was registered. Genetic relatedness of bacteria was evaluated by DiversiLab system.ResultsFifty percent of patients were colonized by multidrug-resistant Gram-negative isolates. Five patients harboured ESBL-producing enterobacteriaceae. No carbapenem-resistant enterobacteriaceae were detected. 13/38 patients were colonized by A. baumannii isolates (resistant to ciprofloxacin but susceptible to carbapenems). There was a significant difference in the prevalence of colonization by A. baumannii between ward 2 and ward 1 (60% vs. 5.6%, p < 0.001). Two clusters of A. baumannii isolates were identified including one isolate detected on a chair in a patient’s room.ConclusionsWe detected a high prevalence of two multidrug-resistant A. baumannii strains in patients with disorder of consciousness at a LTCF in Graz, Austria. Our findings strongly suggest nosocomial cross-transmission between patients. An active surveillance strategy is warranted to avoid missing newly emerging pathogens.

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Multidrug-ResistantAcinetobacter baumanniiInfection, Colonization, and Transmission Related to a Long-Term Care Facility Providing Subacute Care

Cited by 36 publications

References 25 publications

Prevalence of and Risk Factors for Multidrug-ResistantAcinetobacter baumanniiColonization Among High-Risk Nursing Home Residents

Prevalence of and Risk Factors for Multidrug-ResistantAcinetobacter baumanniiColonization Among High-Risk Nursing Home Residents

Failure to Communicate: Transmission of Extensively Drug-Resistantbla_OXA-237-ContainingAcinetobacter baumannii—Multiple Facilities in Oregon, 2012–2014

Colonization of long term care facility patients with MDR-Gram-negatives during an Acinetobacter baumannii outbreak

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Multidrug-ResistantAcinetobacter baumanniiInfection, Colonization, and Transmission Related to a Long-Term Care Facility Providing Subacute Care

Cited by 36 publications

References 25 publications

Prevalence of and Risk Factors for Multidrug-ResistantAcinetobacter baumanniiColonization Among High-Risk Nursing Home Residents

Prevalence of and Risk Factors for Multidrug-ResistantAcinetobacter baumanniiColonization Among High-Risk Nursing Home Residents

Failure to Communicate: Transmission of Extensively Drug-ResistantblaOXA-237-ContainingAcinetobacter baumannii—Multiple Facilities in Oregon, 2012–2014

Colonization of long term care facility patients with MDR-Gram-negatives during an Acinetobacter baumannii outbreak

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Failure to Communicate: Transmission of Extensively Drug-Resistantbla_OXA-237-ContainingAcinetobacter baumannii—Multiple Facilities in Oregon, 2012–2014