TY - JOUR
T1 - Failure to Communicate
T2 - Transmission of Extensively Drug-Resistant blaOXA-237-Containing Acinetobacter baumannii - Multiple Facilities in Oregon, 2012-2014
AU - Buser, Genevieve L.
AU - Cassidy, P. Maureen
AU - Cunningham, Margaret C.
AU - Rudin, Susan
AU - Hujer, Andrea M.
AU - Vega, Robert
AU - Furuno, Jon P.
AU - Marshall, Steven H.
AU - Higgins, Paul G.
AU - Jacobs, Michael R.
AU - Wright, Meredith S.
AU - Adams, Mark D.
AU - Bonomo, Robert A.
AU - Pfeiffer, Christopher D.
AU - Beldavs, Zintars G.
N1 - Funding Information:
Financial support; This work was funded by the Epidemiology and Laboratory Capacity Cooperative Agreement (no. NU50CK000484-01-01 to G.L.B., P.M.C, M.C.C., R.V., J.P.F., C.D.P., and Z.G.B.) with the Centers for Disease Control and Prevention. This work was also supported in part by funds and facilities provided by the Cleveland Department of Veterans Affairs Merit Review Program (grant no. 1I01BX001974 to S.R., A.M.H., S.H.M., P.G.H., M.R.J., M.S.W., M.D.A., and R.A.B.) from the Biomedical Laboratory Research & Development Service of the VA Office of Research and Development and the Geriatric Research Education and Clinical Center VISN 10 to R. A. B. This work was also supported by funds from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (grant nos. R01AI063517, R01AI072219, and R01AI100560 to R.A.B and grant no. U19AI110819 to J.C.V.I.).
Publisher Copyright:
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - 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.
AB - 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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U2 - 10.1017/ice.2017.189
DO - 10.1017/ice.2017.189
M3 - Article
C2 - 28870269
AN - SCOPUS:85040461880
SN - 0899-823X
VL - 38
SP - 1335
EP - 1341
JO - Infection Control and Hospital Epidemiology
JF - Infection Control and Hospital Epidemiology
IS - 11
ER -