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The Epidemiology of Multidrug-Resistant Acinetobacter Baumannii Does the Community Represent a Reservoir?

Published online by Cambridge University Press:  02 January 2015

Cosmina Zeana ,
Elaine Larson ,
Jyoti Sahni ,
S. J. Bayuga ,
Fann Wu  and
Phyllis Della-Latta
Cosmina Zeana*
Affiliation:
Columbia University College of Physicians & Surgeons, New York, New York
Elaine Larson
Affiliation:
Columbia University College of Physicians & Surgeons, New York, New York
Jyoti Sahni
Affiliation:
Southern Illinois University, Carbondale, Illinois
S. J. Bayuga
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York, New York
Fann Wu
Affiliation:
Columbia University College of Physicians & Surgeons, New York, New York
Phyllis Della-Latta
Affiliation:
Columbia University College of Physicians & Surgeons, New York, New York
*
Harlem Hospital, 506 Lenox Avenue, Room 3101 A, New York, NY 10037
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Abstract

Objective:

To explore the role of the community as a potential reservoir for Acinetobacter baumannii.

Design:

Antimicrobial resistance patterns and genotypes of A. baumannii isolates from patients in two Manhattan hospitals were compared with those of A. baumannii isolates from the hands of community members.

Results:

A total of 103 isolates from two hospitals (hospital A, 81; hospital B, 22) and 23 isolates from community residents were studied. Of the hospital isolates, 36.6% were multidrug resistant (hospital A, 68.2%; hospital B, 27.8%). In contrast, there were no multidrug-resistant isolates from the community (P < .005 between hospital and community). The prevalence of A. baumannii on the hands of community residents was 10.4% (23 of 222). By molecular typing, 42 strains of A. baumannii were identified. Of the isolates from hospital A and hospital B, 55.6% (45 of 81) and 68.2% (15 of 22), respectively, were indistinguishable or closely related. In contrast, most community (83.3%) isolates were unrelated (P = .001 between hospital and community).

Conclusion:

Acinetobacter isolates from the community, characterized by a large variety of unrelated strains (83.3%), were distinct from the hospital isolates, of which 58.3% were closely related. The absence of multidrug-resistant strains in the community compared with 36.6% prevalence among hospital isolates suggests that the reservoir for epidemic strains resides in the hospital environment itself. To our knowledge, this is the first study to examine the community as a potential reservoir for hospital strains of A. baumannii.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 4 , April 2003 , pp. 275 - 279
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Garcia-Garmendia, JL, Ortiz-Leyba, C, Garnacho-Montero, J, et al. Risk factors for Acinetobacter baumannii nosocomial bacteremia in critically ill patients: a cohort study. Clin Infect Dis 2001;33:939–946.CrossRefGoogle ScholarPubMed
2.Wisplinghoff, H, Edmond, MB, Pfaller, MA, Jones, RN, Wenzel, RP, Seifert, H. Nosocomial bloodstream infections caused by Acinetobacter species in United States hospitals: clinical features, molecular epidemiology, and antimicrobial susceptibility. Clin Infect Dis 2000;31:690–697.CrossRefGoogle ScholarPubMed
3.Bergogne-Berezin, E, Towner, KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996;9:148–165.CrossRefGoogle ScholarPubMed
4.Villari, P, Iacuzio, L, Vozzella, EA, Bosco, U. Unusual genetic heterogeneity of Acinetobacter baumannii isolates in a university hospital in Italy. Am J Infect Control 1999;27:247–253.CrossRefGoogle Scholar
5.Husni, RN, Goldstein, LS, Arroliga, AC, et al. Risk factors for an outbreak of multi-drug-resistant Acinetobacter nosocomial pneumonia among intubated patients. Chest 1999;115:1378–1382.CrossRefGoogle ScholarPubMed
6.Pillay, T, Pillay, DG, Adhikari, M, Pillay, ASturm, AW. An outbreak of neonatal infection with Acinetobacter linked to contaminated suction catheters. J Hosp Infect 1999;43:299–304.CrossRefGoogle ScholarPubMed
7.Cox, TR, Roland, WE, Dolan, ME. Ventilator-related Acinetobacter outbreak in an intensive care unit. Mil Med 1998;163:389–391.CrossRefGoogle Scholar
8.Patterson, JE, Vecchio, J, Pantelick, EL, et al. Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit. Am J Med 1991;91:479–483.CrossRefGoogle Scholar
9.Weernink, A, Severin, WP, Tjernberg, I, Dijkshoorn, L. Pillows, an unexpected source of Acinetobacter. J Hosp Infect 1995;29:189–199.CrossRefGoogle ScholarPubMed
10.Nagels, B, Ritter, E, Thomas, P, Schulte-Wissermann, H, Wirsing von Konig, CH. Acinetobacter baumannii colonization in ventilated preterm infants. Eur J Clin Microbiol Infect Dis 1998;17:37–40.CrossRefGoogle ScholarPubMed
11.McDonald, IX, Walker, M, Carson, L, et al. Outbreak of Acinetobacter spp. bloodstream infections in a nursery associated with contaminated aerosols and air conditioners. Pediatr Infect Dis J 1998;17:716–722.CrossRefGoogle Scholar
12.Go, ES, Urban, C, Burns, J, et al. Clinical and molecular epidemiology of Acinetobacter infections sensitive only to polymyxin B and sulbactam. Lancet 1994;344:1329–1332.CrossRefGoogle ScholarPubMed
13.D'Agata, EM, Thayer, V, Schaffner, W. An outbreak of Acinetobacter baumannii: the importance of cross-transmission. Infect Control Hosp Epidemiol 2000;21:588–591.CrossRefGoogle ScholarPubMed
14.Fierobe, L, Lucet, JC, Deere, D, et al. An outbreak of imipenem-resistant Acinetobacter baumannii in critically ill surgical patients. Infect Control Hosp Epidemiol 2001;22:35–40.CrossRefGoogle ScholarPubMed
15.Manikal, VM, Landman, D, Saurina, G, Oydna, E, Lai, H, Quale, J. Endemie carbapenem-resistant Acinetobacter species in Brooklyn, New York: citywide prevalence, interinstitutional spread, and relation to antibiotic usage. Clin Infect Dis 2000;31:101–106.CrossRefGoogle Scholar
16.Rahal, JJ, Urban, C, Segal-Maurer, S. Nosocomial antibiotic resistance in multiple gram-negative species: experience at one hospital with squeezing the resistance balloon at multiple sites. Clin Infect Dis 2002;34:499–503.CrossRefGoogle ScholarPubMed
17.Dijkshoorn, L, Aucken, H, Gerner-Smidt, P, et al. Comparison of outbreak and nonoutbreak Acinetobacter baumannii strains by genotypic and phenorypic methods. J Clin Microbiol 1996;34:1519–1525.CrossRefGoogle Scholar
18.Baron, E, Peterson, L, Finegold, S. Bailey and Scott's Diagnostic Microbiology, 9th ed. St. Louis, MO: Mosby; 1994.Google Scholar
19.Isenberg, H. Clinical Microbiology Procedures Handbook, vol. 1. Washington, DC: American Society for Microbiology; 1992.Google Scholar
20.Bean, P, Olive, M. Molecular principles underlying hepatitis C virus diagnosis. Am Clin Lab 2001;20:19–21.Google ScholarPubMed
21.Tenover, FC, Arbeit, RD, Goering, RV. How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Molecular Typing Working Group of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 1997;18:426–439.CrossRefGoogle Scholar
22.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
23.Seifert, H, Dijkshoorn, L, Gerner-Smidt, P, Pelzer, N, Tjernberg, I, Vaneechoutte, M. Distribution of Acinetobacter species on human skin: comparison of phenotypic and genotypic identification methods. J Clin Microbiol 1997;35:2819–2825.CrossRefGoogle ScholarPubMed
24.Chu, YW, Leung, CM, Houang, ET, et al. Skin carriage of Acinetobacter in Hong Kong. J Clin Microbiol 1999;37:2962–2967.CrossRefGoogle ScholarPubMed
25.Dy, ME, Nord, JA, LaBombardi, VJ, Kislak, JW. The emergence of resistant strains of Acinetobacter baumannii: clinical and infection control implications. Infect Control Hosp Epidemiol 1999;20:565–567.CrossRefGoogle ScholarPubMed
26.Bernards, AT, Frenay, HM, Lim, BT, Hendriks, WD, Dijkshoorn, L, van Boven, CP. Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii: an unexpected difference in epidemiologic behavior. Am J Infect Control 1998;26:544–551.CrossRefGoogle ScholarPubMed
27.Thurm, V, Ritter, E. Genetic diversity and clonal relationships of Acinetobacter baumannii strains isolated in a neonatal ward: epidemiological investigations by allozyme, whole-cell protein and antibiotic resistance analysis. Epidemiol Infect 1993;111:491–498.CrossRefGoogle Scholar
28.Spiliopoulou, I, Droukopoulou, A, Athanassiadou, A, Dimitracopoulos, G. Plasmid profiles of Acinetobacter and Enterobacter species of hospital origin: restriction endonuclease analysis of plasmid DNA and transformation of Escherichia coli by R plasmids. J Chemother 1992;4:72–77.CrossRefGoogle ScholarPubMed
29.McDonald, A, Amyes, SG, Paton, R. The persistence and clonal spread of a single strain of Acinetobacter 13TU in a large Scottish teaching hospital. J Chemother 1999;11:338–344.CrossRefGoogle Scholar
30.Webster, CA, Towner, KJ, Saunders, GL, Crewe-Brown, HH, Humphreys, H. Molecular and antibiogram relationships of Acinetobacter isolates from two contrasting hospitals in the United Kingdom and South Africa. Eur J Clin Microbiol Infect Dis 1999;18:595–598.CrossRefGoogle ScholarPubMed
31.Musa, EK, Desai, N, Casewell, MW. The survival of Acinetobacter calcoaceticus inoculated on fingertips and on formica. J Hosp Infect 1990;15:219–227.CrossRefGoogle ScholarPubMed
32.Webster, C, Towner, KJ, Humphreys, H. Survival of Acinetobacter on three clinically related inanimate surfaces. Infect Control Hosp Epidemiol 2000;21:246.CrossRefGoogle ScholarPubMed
33.Debast, SB, Meis, JF, Melchers, WJ, Hoogkamp-Korstanje, JA, Voss, A. Use of interrepeat PCR fingerprinting to investigate an Acinetobacter baumannii outbreak in an intensive care unit. Scand J Infect Dis 1996;28:577–581.CrossRefGoogle Scholar
34.Pina, P, Guezenec, P, Grosbuis, S, Guyot, L, Ghnassia, JC, Allouch, PY. An Acinetobacter baumannii outbreak at the Versailles Hospital Center [in French]. Pathol Biol (Paris) 1998;46:385–394.Google ScholarPubMed
35.Webster, CA, Crowe, M, Humphreys, H, Towner, KJ. Surveillance of an adult intensive care unit for long-term persistence of a multi-resistant strain of Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis 1998;17:171–176.Google ScholarPubMed
36.Ling, ML, Ang, A, Wee, M, Wang, GC. A nosocomial outbreak of multiresistant Acinetobacter baumannii originating from an intensive care unit. Infect Control Hosp Epidemiol 2001;22:48–49.CrossRefGoogle ScholarPubMed
37.Levin, AS, Gobara, S, Mendes, CM, Cursino, MR, Sinto, S. Environmental contamination by multidrug-resistant Acinetobacter baumannii in an intensive care unit. Infect Control Hosp Epidemiol 2001;22:717–720.CrossRefGoogle Scholar
38.Allen, KD, Green, HT. Hospital outbreak of multi-resistant Acinetobacter anitratus: an airborne mode of spread? J Hosp Infect 1987;9:110–119.CrossRefGoogle ScholarPubMed
39.Buxton, AE, Anderson, RL, Werdegar, D, Atlas, E. Nosocomial respiratory tract infection and colonization with Acinetobacter calcoaceticus: epidemiologic characteristics. Am J Med 1978;65:507–513.CrossRefGoogle ScholarPubMed
40.Riley, TV, Webb, SA, Cadwallader, H, Briggs, BD, Christiansen, L, Bowman, RA. Outbreak of gentamicin-resistant Acinetobacter baumannii in an intensive care unit: clinical, epidemiological, and microbiological features. Pathology 1996;28:359–363.CrossRefGoogle Scholar
41.Roberts, SA, Findlay, R, Lang, SD. Investigation of an outbreak of multidrug resistant Acinetobacter baumannii in an intensive care burns unit. J Hosp Infect 2001;48:228–232.CrossRefGoogle Scholar
42.Cardoso, CL, Pereira, HH, Zequim, JC, Guilhermetti, M. Effectiveness of hand-cleansing agents for removing Acinetobacter baumannii strain from contaminated hands. Am J Infect Control 1999;27:327–331.CrossRefGoogle ScholarPubMed