377. Investigation of an Outbreak of Multidrug Resistant Acinetobacter baumannii in a Surgical Intensive Care Unit
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Acinetobacter species are well known causes of healthcare-associated infections. MDR phenotypes are challenging to treat and can cause epidemics. A sudden, persistent increase in MDR Acinetobacter infections occurred beginning in June, 2006 at Temple University Hospital. Analysis of hospital culture data showed that the majority of the infections were in the SICU.
Methods: MDR Acinetobacter were defined as susceptible only to colistin and/or tigecycline. A retrospective 1:2 case-control study was done for the period June - August, 2006. Cases were SICU patients infected or colonized with MDR Acinetobacter. Controls were SICU patients during the same time period who were neither colonized nor infected with MDR Acinetobacter. Clinical patient isolates and environmental cultures were analyzed with repetitive extragenic palindromic-PCR (rep-PCR) analysis.
Results: SICU MDR Acinetobacter incidence rates rose from <4.1 cases/1000 pt days (pre-epidemic) to 14. Increased numbers of ICU days, ventilator days, number of antibiotics and antibiotic days were significant risk factors for MDR Acinetobacter. Two of 44 environmental cultures grew MDR Acinetobacter. By rep-PCR, 25/39 MDR Acinetobacter isolates were identical; 7 were a different clone; the rest were mixed. A decline in SICU MDR Acinetobacter infections was observed after the study period.
Conclusion: We had an MDR Acinetobacter epidemic in our SICU in 2006. One clone predominated, but it was not found in the environment. MDR Acinetobacter patients were hospitalized for longer periods and were more highly ventilator and antibiotic exposed than other SICU patients. These factors may have amplified problems with infection control leading to this outbreak. The outbreak was controlled by simple interventions such as education, targeted surveillance cultures, improved hand hygiene compliance and improved environmental cleaning.
Peter Axelrod, MD1, Jihoon Baang, MD1, Robert Bonomo, MD2, Georgia Dash, RN, BSN, MS3, Brooke Decker, MD4, Thomas Fekete, MD1, Allan Truant, PhD1 and  J. Baang, None..
P. Axelrod, None..
G. Dash, None..
A. Truant, None..
R. A. Bonomo, None..
B. K. Decker, None..
T. Fekete, None., (1)Temple University Hospital, Philadelphia, PA, (2)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (3)Cape Cod Healthcare, Hyannis, MA, (4)University Hospitals Case Medical Center, Cleveland, OH