Outbreak of carbapenem-resistant Acinetobacter baumannii in the intensive care unit: a multi-level strategic management approach

Molter, G.; Seifert, Harald; Mandraka, Falitsa; Kasper, Gregory; Weidmann, Bernd; Hornei, B.; Öhler, M.; Schwimmbeck, Peter L.; Kröschel, P.; Higgins, Paul G.; Reuter, Stefan

doi:10.1016/j.jhin.2015.11.007

Cited by 38 publications

(44 citation statements)

References 9 publications

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“…Another potential drawback is that we did not investigate the indications of antimicrobial use in our analysis. However, a well-established integrated ASP has been implemented in the hospital for a decade; each prescription was carefully reviewed daily by both pharmacists and infection diseases specialists [10, 12]. As a result, decisions regarding antimicrobial use were attributable to responsible clinicians; appropriate use of antimicrobial agents could be expected in the study.…”

Section: Discussionmentioning

confidence: 99%

“…An integrated, multidisciplinary approach is advocated to control the growing threat of MDRAB-related infection or colonization. Proposed responses have included changes in hand hygiene, surveillance, cohort policy, environmental disinfection and cleaning, contact isolation, decolonization, the use of chlorhexidine baths, and antibiotic stewardship programs (ASPs), all with the intent of eliminating this bacterium’s reservoir, transmission, and source [7–10]. …”

Section: Introductionmentioning

confidence: 99%

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Acquisition and clearance of multidrug resistant Acinetobacter baumannii on healthy young adults concurrently burned in a dust explosion in Taiwan: the implication for antimicrobial stewardship

Huang

Shie

et al. 2017

BMC Infect Dis

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BackgroundInformation is limited about the effect of restricted carbapenem use on clearance of multi-drug resistant Acinetobacter baumannii (MDRAB). We sought to determine the time effect of antibiotic exposure on multi-drug resistant Acinetobacter baumannii (MDRAB) acquisition and clearance.MethodsWe conducted a retrospective observational study at the intensive care units of a tertiary medical center. Forty-two of a cohort of previously healthy young adults who were concurrently burned by a dust explosion was included. Cases consisted of those from whom MDRAB was isolated during hospitalization. Controls consisted of patients from whom MDRAB was not isolated in the same period. Use of antimicrobial agents was compared based on days of therapy per 1,000 patient-days (DOT/1,000PD). A 2-state Markov multi-state model was used to estimate the risk of acquisition and clearance of MDRAB.ResultsMDRAB was discovered in 9/42 (21.4%) individuals. The cases had significantly higher use of carbapenem (652 DOT/1,000PD vs. 385 DOT/1,000PD, P < 0.001) before MDRAB isolation. For the cases, clearance of MDRAB was associated with lower use of carbapenem (469 DOT/1,000PD vs. 708 DOT/1,000PD, P = 0.003) and higher use of non-carbapenem beta-lactam (612 DOT/1,000PD vs. 246 DOT/1,000PD, P <0.001). In multi-state model, each additional DOT of carbapenem increased the hazard of acquiring MDRAB (hazard ratio (HR), 1.08; 95% confidence interval (CI) 1.01–1.16) and each additional DOT of non-carbapenem beta-lactam increased the protection of clearing MDRAB (HR, 1.25; 95% CI 1.07–1.46).ConclusionsBoth acquisition and clearance of MDRAB were related to antibiotic exposure in a homogeneous population. Our findings suggest that early discontinuation of carbapenem could be an effective measure in antibiotic stewardship for the control of MDRAB spreading.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acquisition and clearance of multidrug resistant Acinetobacter baumannii on healthy young adults concurrently burned in a dust explosion in Taiwan: the implication for antimicrobial stewardship

Huang

Shie

et al. 2017

BMC Infect Dis

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“…Identification of A. baumannii has been done mostly by the VITEK-2 system, MALDI-TOF [18,26] and detection of the intrinsic blaOXA-51-like gene [30]. Phenotypic antibiotic sensitivity testing (AST) was performed with the VITEK-2 platform, E-test [28], disk diffusion method [24], antibiotic gradient test and micro-broth dilution using Micronaut-S system [22].…”

Section: Identification Of a Baumannii And Antibiotic Susceptibilitymentioning

confidence: 99%

“…The strain was resistant to imipenem, meropenem, penicillins, cephalosporins, ciprofloxacin, gentamicin, tobramycin and tigecycline and was related to the pan-European A. baumannii clone II [16]. Since then, carbapenemase-producing strains have been recovered from several outbreaks every year [26,27,30,33,62]. According to the National Reference Laboratory for Gram-negative nosocomial pathogens at the Ruhr-University Bochum, CRAb was found in 96.3% of strains and blaOXA-23 was the most frequent carbapenemase in A. baumannii (81.1%) in 2011 [41].…”

Section: Resistance Development Of a Baumanniimentioning

confidence: 99%

Spatio-Temporal Distribution of Acinetobacter baumannii in Germany—A Comprehensive Systematic Review of Studies on Resistance Development in Humans (2000–2018)

et al. 2020

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Acinetobacter (A.) baumannii has gained global notoriety as a significant nosocomial pathogen because it is frequently associated with multi-drug resistance and hospital-based outbreaks. There is a substantial difference in the incidence of A. baumannii infections between different countries and within Germany. However, its continuous spread within Germany is a matter of concern. A systematic literature search and analysis of the literature published between 2000 and 2018 on A. baumannii in humans was performed. Forty-four studies out of 216 articles met the criteria for inclusion, and were selected and reviewed. The number of published articles is increasing over time gradually. Case reports and outbreak investigations are representing the main body of publications. North Rhine-Westphalia, Hesse and Baden-Wuerttemberg were states with frequent reports. Hospitals in Cologne and Frankfurt were often mentioned as specialized institutions. Multiresistant strains carrying diverse resistance genes were isolated in 13 of the 16 German states. The oxacillinase blaOXA-23-like, intrinsic blaOXA-51-like, blaOXA-58 variant, blaNDM-1, blaGES-11, blaCTX-M and blaTEM are the most predominant resistance traits found in German A. baumannii isolates. Five clonal lineages IC-2, IC-7, IC-1, IC-4 and IC-6 and six sequence types ST22, ST53, ST195, ST218, ST944/ST78 and ST348/ST2 have been reported. Due to multidrug resistance, colistin, tigecycline, aminoglycosides, fosfomycin, ceftazidime/avibactam and ceftolozan/tazobactam were often reported to be the only effective antibiotics left to treat quadruple multi-resistant Gram-negative (4MRGN) A. baumannii. Dissemination and infection rates of A. baumannii are on the rise nationwide. Hence, several aspects of resistance development and pathogenesis are not fully understood yet. Increased awareness, extensive study of mechanisms of resistance and development of alternative strategies for treatment are required. One-Health genomic surveillance is needed to understand the dynamics of spread, to identify the main reservoirs and routes of transmission and to develop targeted intervention strategies.

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“…In recent years, wide dissemination and hospital outbreaks of multidrug-resistant A. baumannii strains have been reported (3–5). Here, we report the draft genome sequences of two carbapenemase-producing A. baumannii strains, H31499 and H31506.…”

Section: Genome Announcementmentioning

confidence: 99%

Draft Genome Sequences of Two Carbapenemase-Producing Acinetobacter baumannii Clinical Strains Isolated from Albanian and Togolese Patients

et al. 2017

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Outbreak of carbapenem-resistant Acinetobacter baumannii in the intensive care unit: a multi-level strategic management approach

Cited by 38 publications

References 9 publications

Acquisition and clearance of multidrug resistant Acinetobacter baumannii on healthy young adults concurrently burned in a dust explosion in Taiwan: the implication for antimicrobial stewardship

Acquisition and clearance of multidrug resistant Acinetobacter baumannii on healthy young adults concurrently burned in a dust explosion in Taiwan: the implication for antimicrobial stewardship

Spatio-Temporal Distribution of Acinetobacter baumannii in Germany—A Comprehensive Systematic Review of Studies on Resistance Development in Humans (2000–2018)

Draft Genome Sequences of Two Carbapenemase-Producing Acinetobacter baumannii Clinical Strains Isolated from Albanian and Togolese Patients

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