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Failure to Communicate: Transmission of Extensively Drug-Resistant bla OXA-237 -Containing Acinetobacter baumannii —Multiple Facilities in Oregon, 2012–2014
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Failure to Communicate: Transmission of Extensively Drug-Resistant bla OXA-237 -Containing Acinetobacter baumannii —Multiple Facilities in Oregon, 2012–2014
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Failure to Communicate: Transmission of Extensively Drug-Resistant bla OXA-237 -Containing Acinetobacter baumannii —Multiple Facilities in Oregon, 2012–2014
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Journal Article
Failure to Communicate: Transmission of Extensively Drug-Resistant bla OXA-237 -Containing Acinetobacter baumannii —Multiple Facilities in Oregon, 2012–2014
2017
Overview
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.
Subject
Acinetobacter baumannii - drug effects
/ Acinetobacter baumannii - genetics
/ Acinetobacter Infections - drug therapy
/ Acinetobacter Infections - epidemiology
/ Acinetobacter Infections - transmission
/ Adult
/ Aged
/ Cross Infection - drug therapy
/ Cross Infection - epidemiology
/ Cross Infection - transmission
/ Drug Resistance, Multiple, Bacterial
/ Electrophoresis, Gel, Pulsed-Field
/ Female
/ Humans
/ Male
