Complex Infection-Control Measures with Disinfectant Switch Help the Successful Early Control of Carbapenem-Resistant Acinetobacter baumannii Outbreak in Intensive Care Unit
Abstract
:1. Introduction
2. Results
2.1. Description of the Outbreak
2.2. Environmental Investigations
2.3. Infection-Control Measures during the Outbreak
2.4. Characteristics of CRAB Strains of This Outbreak
2.4.1. Biofilm-Forming Capacity
2.4.2. Antibiotic Susceptibility
2.4.3. Disinfectant Susceptibility of the Planktonic and Biofilm-Forming Phase of CRAB
2.4.4. Killing Curve Assay with the Two Different Surface Disinfectants—MBF and IP—Used during the Outbreak
2.4.5. Genomic Analysis
2.4.6. Real-Time PCR Assay to Determine the Relative Expression Rate of qacE and qacEΔ1
3. Discussion
4. Materials and Methods
4.1. Study Design
4.2. Environmental Sampling
4.3. Bacterial Strain
4.4. Minimal Inhibitory Concentration and Minimal Bactericidal Concentration Determination
4.5. Killing Curve Assay
4.6. Investigation of Biofilm Production
4.7. Minimum Biofilm Inhibitory Concentration (MBIC) Determination
4.8. Whole-Genome Sequencing (WGS)
4.9. Analysis of Disinfectant Resistance Genes by Quantitative PCR
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | All Patients (n = 291) |
---|---|
Age (years) | 55.4 (38–85) |
Gender, male | 135 (46%) |
Neurosurgical disease | |
CNS tumor | 175 (60%) |
Subarachnoid hemorrhage | 62 (21%) |
Other hemorrhages | 22 (46%) |
Stroke | 32 (7%) |
Surgical treatment | |
Neurosurgical operation | 207 (71%) |
Endovascular treatment | 84 (29%) |
Underlying diseases | |
Hypertension | 42 (14%) |
Diabetes mellitus | 49 (16%) |
Others | 64 (22%) |
Infection | |
Urinary tract infection | 34 (11.6%) |
Pneumonia | 19 (7%) |
Wound infection | 10 (3.4%) |
Bloodstream infection | 7 (2%) |
Meningitis | 3 (1%) |
Death | 12 (4%) |
Patient | Age (Years) | Gender | Underlying Diseases | Surgical Procedure | Multiresistant Bacteria | CRAB-Positive Specimens | Infection/Colonization | Antibiotic Treatment | Duration of Hospital Stay (Days) | Outcome |
---|---|---|---|---|---|---|---|---|---|---|
P1 | 37 | male | intracranial hemorrhage, hypertension | craniotomy | CRAB, MRSA | trachea | colonization | imipenem/cilastatin | 29 | discharged |
P2 | 63 | male | subarachnoid hemorrhage, hypertension | craniotomy | CRAB, VRE | urine, liquor, anorectal | infection: UTI, meningitis | colomycin, imipenem/cilastatin | 58 | discharged |
P3 | 48 | female | stroke, hypertension | intervention | CRAB | bloodculture | infection: BSI | colomycin | 12 | discharged |
P4 | 67 | female | AVM angiomatis, hypertension, diabetes mellitus, COPD | craniotomy | CRAB | trachea | colonization | imipenem/cilastatin, vancomycin, meropenem | 6 | discharged |
P5 | 76 | female | cerebral metastasis, hypertension, hypothyreosis, breast cancer | craniotomy | CRAB, ESBL-KP, VRE | wound, nasal, bloodculture | infection: SSI, BSI | colomycin, meropenem, vancomycin, linezolid, gentamycin | 36 | exit |
P6 | 53 | male | subarachnoid hemorrhage, hypertension, diabetes mellitus | craniotomy | CRAB, ESBL-KP, VRE | trachea, bloodculture, anorectal | infection: VAP, BSI | colomycin, ceftriaxone, cefatizidime, imipenem/cilastatin, meropenem, levofloxacin | 38 | discharged |
Before CRAB Outbreak | During CRAB Outbreak | After CRAB Outbreak | |
---|---|---|---|
Enforcement of hand hygiene | |||
Regular education programs on hand hygiene | yearly | weekly, including circulating staff | every six months |
Audit of hand hygiene compliance | every six month | daily | weekly |
Universal contact precautions | |||
earing gloves, coat, apron, and shoe protector in the patient zone | in case of MDR-positive patients | in case of MDR-positive patients and their contacts | in case of MDR-positive patients and their contacts |
Wearing of personal protective equipment by HCWs | yes | yes | yes |
Access restrictions | yes | yes | yes |
Review of invasive procedures | yes | yes | yes |
Cohort isolation | |||
cohort isolation of colonized patient | no | yes | yes |
Healthcare worker cohorting (HCW), patient:HCW ratio | 3:1 | 2:1 | 3:1 |
Surveillance cultures | |||
Passive surveillance: antibiogram monitoring | yes | yes | yes |
Active surveillance: screening cultures | no | initial (in 24 h) and in every 5 days | initial (in 24 h) and weekly |
Environmental surveillance cultures | occasionally | once a week | every three months |
Patient decolonization | |||
Throat decolonizitation with chlorhexidine digluconate | no | yes | yes |
Environmental cleaning and disinfection | |||
Extensive management using checklists under the supervision of the unit manager | no | yes | yes |
Patient zone | twice a day | three times a day, and necessery | three times a day, and necessery |
Environment except the patient zone | twice a day | three times a day | three times a day |
Cleaning personnel | two persons for the unit | three cohorting cleaning persons for the unit | three cohorting cleaning persons for the unit |
Improved waste management | yes | yes | yes |
Touchless environmental disinfection systems (e.g., vaporized hydrogen peroxide) | yes | yes | yes |
Developing a purposeful disinfectant policy | |||
Disinfection stewardship | no | Disinfection switch | yes |
Antibiotic stewardship | yes | yes | yes |
Genomic surveillance | |||
Whole-genome sequencing | no | yes | no |
Monitoring and feedback | |||
Discussions on the performance of the infection-control strategy | monthly | daily | weekly |
Disinfectants | Acinetobacter baumannii | Acinetobacter baumannii | ||||||
---|---|---|---|---|---|---|---|---|
Outbreak CRAB | BAA-1805 | |||||||
MIC | MBC | MBC/MIC | MBIC | MIC | MBC | MBC/MIC | MBIC | |
Benzalkonium chloride | 32 | 32 | 1 | 0.5 | 16 | 32 | 2 | <0.06 |
2-phenoxyethanol | 0.5 | 0.25 | 2 | 0.0078 | 0.25 | 0.25 | 1 | 0.0078 |
Chlorhexidine digluconate | 16 | 32 | 2 | 0.25 | 32 | 64 | 2 | 8 |
Multilocus sequence typing (Pasteur schema) | ST2 |
Beta-lactamases | blaOXA-83 (OXA-51-like) |
blaADC-30 | |
Fluoroquinolone resistance determinants | gyrA: Ser81Leu parC: Ser84Leu |
Aminoglycoside resistance genes | ant(3″)-II (aminoglycoside nucleotidyltransferase) aph(6)-Id (aminoglycoside O-phosphotransferase) aph(3″)-Ib (aminoglycoside O-phosphotransferase) aac(6’)-Ia (aminoglycoside 6′-N-acetyltransferase) |
Efflux pumps | adeABC; adeFGH; adeIJK; adeRS; adeL; adeN |
Disinfectant, antiseptic resistance determinants | qacE; qacEΔ1 |
Biofilm formation | pgaABCD; csuA/B, csuABCDE; bfmR; bfmS; ompA |
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Kelemen, J.; Sztermen, M.; Dakos, E.K.; Budai, J.; Katona, J.; Szekeressy, Z.; Sipos, L.; Papp, Z.; Stercz, B.; Dunai, Z.A.; et al. Complex Infection-Control Measures with Disinfectant Switch Help the Successful Early Control of Carbapenem-Resistant Acinetobacter baumannii Outbreak in Intensive Care Unit. Antibiotics 2024, 13, 869. https://doi.org/10.3390/antibiotics13090869
Kelemen J, Sztermen M, Dakos EK, Budai J, Katona J, Szekeressy Z, Sipos L, Papp Z, Stercz B, Dunai ZA, et al. Complex Infection-Control Measures with Disinfectant Switch Help the Successful Early Control of Carbapenem-Resistant Acinetobacter baumannii Outbreak in Intensive Care Unit. Antibiotics. 2024; 13(9):869. https://doi.org/10.3390/antibiotics13090869
Chicago/Turabian StyleKelemen, Jozsef, Marton Sztermen, Eva Krisztina Dakos, Jozsef Budai, Jozsef Katona, Zsuzsanna Szekeressy, Laszlo Sipos, Zoltan Papp, Balazs Stercz, Zsuzsanna A. Dunai, and et al. 2024. "Complex Infection-Control Measures with Disinfectant Switch Help the Successful Early Control of Carbapenem-Resistant Acinetobacter baumannii Outbreak in Intensive Care Unit" Antibiotics 13, no. 9: 869. https://doi.org/10.3390/antibiotics13090869