Carbapenem-resistant A. baumannii (CRAB) is reportable in Colorado with 3 to 11 cases detected annually. Between December 2017 and February 2018, Denver Health Medical Center (DHMC) detected 2 inpatients with CRAB in urine. The hospital and the Colorado Department of Public Health and Environment (CDPHE) conducted an investigation to determine epidemiologic links and molecular relatedness of the isolates.
We reviewed medical records and performed infection control observations among staff. Pulsed-field gel electrophoresis (PFGE) was performed at CDPHE; antimicrobial susceptibility (AST) and carbapenemase testing was performed at CDC.
Epidemiologic investigation: Both patients had neurogenic bladders managed by suprapubic catheters, stage IV decubitus ulcers, and recent surgery. Neither had traveled outside of Colorado. Although both received recent antibiotics, neither received a carbapenem in the 6 previous months. Both isolates were regarded to be asymptomatic bacteriuria.
In November 2017, the patients overlapped for 7 days at DHMC on different units. During this week, the same nurse provided wound care for both patients on the same day. Observations of the wound care team revealed opportunities to improve hand hygiene prior to donning and after doffing gloves, the use of single-use scissors on multiple patients, and inconsistent cleaning of a mobile device used to photograph wounds.
Microbiologic and molecular investigations: Isolates from the two patients were indistinguishable by PFGE. AST found both isolates susceptible to colistin, but resistant to all other antimicrobials tested [Table 1]; both harbored OXA-23-like genes by a Research Use Only assay performed at CDC.
These are the first carbapenemase-producing A. baumannii strains identified in Colorado. We suspect that they were transmitted during the overlapping hospital admission, although we could not determine where the organism originated or the route of transmission. Opportunities to improve hand hygiene and low level disinfection were identified. The emergence of previously undetected carbapenemases in Colorado is of great public health concern; collaboration between public health and healthcare facilities is critical to halt transmission of novel regional pathogens.
S. J. Janelle, None
B. Knepper, None
J. Kurtz, None
A. Miller, None
S. Reese, None
K. Schutz, None
W. Bamberg, None
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