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Molecular and Epidemiologic Study of Polyclonal Outbreaks of Multidrug-Resistant Acinetobacter baumannii Infection in an Israeli Hospital

Published online by Cambridge University Press:  02 January 2015

Dror Marchaim ,
Shiri Navon-Venezia ,
Azita Leavitt ,
Irina Chmelnitsky ,
Mitchell J. Schwaber  and
Yehuda Carmeli
Dror Marchaim*
Affiliation:
Division of Epidemiology, Tel-Aviv Sourasky Medical Center, Sadder School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Shiri Navon-Venezia
Affiliation:
Division of Epidemiology, Tel-Aviv Sourasky Medical Center, Sadder School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Azita Leavitt
Affiliation:
Division of Epidemiology, Tel-Aviv Sourasky Medical Center, Sadder School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Irina Chmelnitsky
Affiliation:
Division of Epidemiology, Tel-Aviv Sourasky Medical Center, Sadder School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Mitchell J. Schwaber
Affiliation:
Division of Epidemiology, Tel-Aviv Sourasky Medical Center, Sadder School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Yehuda Carmeli
Affiliation:
Division of Epidemiology, Tel-Aviv Sourasky Medical Center, Sadder School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
*
Division of Epidemiology, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv, 64239, Israel ([email protected])
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Abstract

Objectives.

To perform a molecular and epidemiologic investigation of multidrug-resistant (MDR) Acinetobacter baumannii in an institution were polyclonal outbreaks have been observed and determine whether these polyclonal outbreaks had an endogenous origin or were caused by in-hospital patient-to-patient transmission.

Design.

Retrospective analysis of prospectively collected data.

Setting.

An epidemiologic and genotypic investigation of incident cases of MDR A. baumannii infection in an Israeli university tertiary care center.

Patients.

Hospitalized patients with MDR A. baumannii isolated from clinical samples during a 13-week period, from April 15, 2003, through July 15, 2003.

Intervention.

All patients with new MDR A. baumannii infections were recruited, and isolates were typed using pulsed-field gel electrophoresis. Data on in-hospital movements and consultations were extracted from computerized databases. Quantification of transmission opportunities (TOPs), defined as encounters between an established carrier and a future carrier of MDR A. baumannii, and analysis of ward clusters were performed.

Results.

We studied 96 MDR A. baumannii isolates, which belonged to 18 different pulsed-field gel electrophoresis clones. In 65% of cases, TOPs involving patients with the same clone were demonstrated, which is significantly greater than the number of TOPs involving patients with different clones (P = .01).

Conclusion.

Although outbreaks of MDR A. baumannii infection may be polyclonal, we believe that patient-to-patient transmission explains most cases of transmission. Polyclonal local outbreaks reflect several clonal outbreaks occurring simultaneously. The cause of polyclonal outbreaks of A. baumannii infections clustered by ward and time remains to be explained.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 8 , August 2007 , pp. 945 - 950
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1. Abbo, A, Navon-Venezia, S, Hammer-Muntz, O, Krichali, T, Siegman-Igra, Y, Carmeli, Y. Multidrug-resistant Acinetobacter baumannii . Emerg Infect Dis 2005;11:22–29.Google Scholar
2. Allen, DM, Hartman, BJ. Acinetobacter species. In: Mandeli, GL, Bennett, IE, Dolin, R, eds. Mandeli, Douglas and Bennett's Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, PA: Churchill Livingstone; 2004:2631–2635.Google Scholar
3. Cisneros, JM, Rodriguez-Bano, J. Nosocomial bacteremia due to Acinetobacter baumannii: epidemiology, clinical features and treatment. Clin Microbiol Infect 2002;8:687–693.Google Scholar
4. Jones, RN. Resistance patterns among nosocomial pathogens: trends over the past few years. Chest 2001;119:397S–404S.CrossRefGoogle ScholarPubMed
5. Van Looveren, M, Goossens, H. Antimicrobial resistance of Acinetobacter spp in Europe. Clin Microbiol Infect 2004;10:684–704.Google Scholar
6. Paul, M, Weinberger, M, Siegman-Igra, Y, et al. Acinetobacter baumannii: emergence and spread in Israeli hospitals 1997-2002. J Hosp Infect 2005;60:256–260.Google Scholar
7. Coelho, J, Woodford, N, Turton, J, Livermore, DM. Multiresistant Acinetobacter in the UK: how big a threat? J Hosp Infect 2004;58:167–169.CrossRefGoogle ScholarPubMed
8. Jain, R, Danziger, LH. Multidrug-resistant Acinetobacter infections: an emerging challenge to clinicians. Ann Pharmacother 2004;38:1449–1459.Google Scholar
9. Levin, AS. Multiresistant Acinetobacter infections: a role for sulbactam combinations in overcoming an emerging worldwide problem. Clin Microbiol Infect 2002;8:144–153.Google Scholar
10. Levin, AS. Treatment of Acinetobacter spp infections. Expert Opin Pharmacother 2003;4:1289–1296.Google Scholar
11. Landman, D, Quale, IM, Mayorga, D, et al. Citywide clonal outbreak of multiresistant Acinetobacter baumannii and Pseudomonas aeruginosa in Brooklyn, NY: the preantibiotic era has returned. Arch Intern Med 2002;162:1515–1520.CrossRefGoogle ScholarPubMed
12. Nemec, A, Dijkshoorn, L, van der Reijden, TJ. Long-term predominance of two pan-European clones among multi-resistant Acinetobacter baumannii strains in the Czech Republic. J Med Microbiol 2004;53:147–153.Google Scholar
13. van Dessel, H, Dijkshoorn, L, van der Reijden, T, et al. Identification of a new geographically widespread multiresistant Acinetobacter baumannii clone from European hospitals. Res Microbiol 2004;155:105–112.Google Scholar
14. Biendo, M, Laurans, G, Lefebvre, JF, Daoudi, F, Eb, F. Epidemiological study of an Acinetobacter baumannii outbreak by using a combination of antibiotyping and ribotyping. J Clin Microbiol 1999;37:2170–2175.Google Scholar
15. Lyytikainen, O, Koljalg, S, Harma, M, Vuopio-Varkila, J. Outbreak caused by two multi-resistant Acinetobacter baumannii clones in a burns unit: emergence of resistance to imipenem. J Hosp Infect 1995;31:41–54.Google Scholar
16. van den Broek, PJ, Arends, J, Bernards, AT, et al. Epidemiology of multiple Acinetobacter outbreaks in The Netherlands during the period 1999-2001. Clin Microbiol Infect 2006;12:837–843.CrossRefGoogle ScholarPubMed
17. Chang, HC, Wei, YF, Dijkshoorn, L, Vaneechoutte, M, Tang, CT, Chang, TC. Species-level identification of isolates of the Acinetobacter calcoace-ticus-Acinetobacter baumannii complex by sequence analysis of the 16S-23S rRNA gene spacer region. J Clin Microbiol 2005;43:1632–1639.Google Scholar
18. National Committee for Clinical Laboratory Standards (NCCLS). Performance Standards for Antimicrobial Susceptibility Testing: 13th Informational Supplement. Wayne, PA: NCCLS; 2003:M100–S13.Google Scholar
19. Maslow, J, Slutsky, A, Arbeit, R. The application of pulsed-field gel electrophoresis to molecular epidemiology In: Persing, D, Smith, T, Tenover, F, White, T, eds. Diagnostic Molecular Microbiology: Principles and Application. Washington, DC: American Society of Microbiology; 1994.Google Scholar
20. 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.Google Scholar
21. Gouby, A, Carles-Nurit, MJ, Bouziges, N, Bourg, G, Mesnard, R, Bouvet, PJ. Use of pulsed-field gel electrophoresis for investigation of hospital outbreaks of Acinetobacter baumannii . J Clin Microbiol 1992;30:1588–1591.Google Scholar
22. Bou, G, Cervero, G, Dominguez, MA, Quereda, C, Martinez-Beltran, J. PCR-based DNA fingerprinting (REP-PCR, AP-PCR) and pulsed-field gel electrophoresis characterization of a nosocomial outbreak caused by imipenem- and meropenem-resistant Acinetobacter baumannii . Clin Microbiol Infect 2000;6:635–643.Google Scholar
23. Vila, J, Marcos, MA, Jimenez de Anta, MT. A comparative study of different PCR-based DNA fingerprinting techniques for typing of the Acinetobacter calcoaceticus-A. baumannii complex. J Med Microbiol 1996;44:482–489.Google Scholar
24. Chen, MZ, Hsueh, PR, Lee, LN, Yu, CJ, Yang, PC, Luh, KT. Severe community-acquired pneumonia due to Acinetobacter baumannii . Chest 2001;120:1072–1077.Google Scholar
25. Bonten, MJ, Slaughter, S, Ambergen, AW, et al. The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 1998;158:1127–1132.Google Scholar