Failure to Communicate: Transmission of Extensively Drug-Resistant blaOXA-237-Containing Acinetobacter baumannii—Multiple Facilities in Oregon, 2012–2014. (5th September 2017)

• Record Type: Journal Article
• Authors: Buser, Genevieve L.; Cassidy, P. Maureen; Cunningham, Margaret C.; Rudin, Susan; Hujer, Andrea M.; Vega, Robert; Furuno, Jon P.; Marshall, Steven H.; Higgins, Paul G.; Jacobs, Michael R.; Wright, Meredith S.; Adams, Mark D.; Bonomo, Robert A.; Pfeiffer, Christopher D.; Beldavs, Zintars G.
• Is Part Of: Infection control and hospital epidemiology. Volume 38:Number 11(2017)
• Page Start: 1335
• Page End: 1341
• Publication Date: 2017-09-05
• Subjects: Nosocomial infections -- Epidemiology -- Periodicals; Health facilities -- Sanitation -- Periodicals; Hospital buildings -- Sanitation -- Periodicals; Cross Infection -- Periodicals; Epidemiology -- Periodicals; Hospitals -- Periodicals; Infection Control -- Periodicals; 614.44
• DOI: 10.1017/ice.2017.189
• Languages: English
• ISSNs: 0899-823X

Abstract

Abstract : 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 bla OXA-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. Infect Control Hosp Epidemiol 2017;38:1335–1341