Acinetobacter baumanii complex organisms have been associated with outbreaks in many ICUs around the world. This group of organisms is particularly concerning due to its ability to accept foreign DNA, allowing it to gain resistance mechanisms. In the summer of 2006, multidrug-resistant A. baumanii was isolated from multiple patients in the Burn Center of Arkansas Children's Hospital (ACH).
Purpose We sought to fully evaluate the scope and determine the source of this A. baumanii outbreak.
Methods Microbiology and patient records were reviewed retrospectively for bacterial resistance, antibiotic exposure, patient condition, and length of stay. Environmental samples were obtained for culture. Infection control practices were observed and reinforced. Environmental and patient isolates were sent to the Arkansas Department of Health and Human Services for DNA fingerprinting analysis.
Results A. baumanii was isolated from five patients in the burn unit between August 5 and 28, 2006. Three of these patients had A. baumanii bacteremia. Patients were adults treated for skin wounds. Three patients had burns. One patient had toxic epidermal necrolysis, and one had extensive pressure ulcers. Isolates were tested for susceptibility by BD Phoenix and verified by E-Test according to CLSI criteria. Susceptibility patterns were similar for four isolates, which were resistant to meropenem, tobramycin, gentamicin, aztreonam, piperacillin/tazobactam, cefepime, and ciprofloxacin but susceptible to colistin; two were intermediate to amikacin. Review of microbiology records revealed an additional burn unit patient with A. baumanii with a similar resistance pattern. This isolate grew from both tissue and tracheal aspirate several months before the described outbreak at the patient's admission to ACH after transfer from another facility. This patient's hospitalization overlapped temporally with one patient in the August outbreak. Environmental cultures were taken from patient and treatment rooms, showers, sinks, doors, and respiratory equipment. One isolate, from a door between two infected patient rooms, grew A. baumanii with the same resistance pattern as the patient isolates. The results of the DNA fingerprinting analysis showed that the outbreak isolates, environmental sample, and index case were genetically similar.
Conclusion The source of the outbreak was likely a patient transferred from another facility. Strict infection control practices and enhanced surveillance were necessary to contain the outbreak.
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