Failure to Communicate: Transmission of Extensively Drug-Resistant blaOXA-237-Containing Acinetobacter baumannii - Multiple Facilities in Oregon, 2012-2014

Genevieve L. Buser, P. Maureen Cassidy, Margaret C. Cunningham, Susan Rudin, Andrea M. Hujer, Robert Vega, Jon P. Furuno, Steven H. Marshall, Paul G. Higgins, Michael R. Jacobs, Meredith S. Wright, Mark D. Adams, Robert A. Bonomo, Christopher Pfeiffer, Zintars G. Beldavs

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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 blaOXA-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.

Original languageEnglish (US)
Pages (from-to)1335-1341
Number of pages7
JournalInfection control and hospital epidemiology
Volume38
Issue number11
DOIs
StatePublished - Nov 1 2017

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Acinetobacter baumannii
Skilled Nursing Facilities
Disease Outbreaks
Pharmaceutical Preparations
Pulsed Field Gel Electrophoresis
meropenem
Communication
Long-Term Care
Delivery of Health Care
Patient Transfer
Chlorhexidine
Imipenem
Environmental Monitoring
Baths
Medical Records
Plasmids
Anti-Bacterial Agents
Genes

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Failure to Communicate : Transmission of Extensively Drug-Resistant blaOXA-237-Containing Acinetobacter baumannii - Multiple Facilities in Oregon, 2012-2014. / Buser, Genevieve L.; Cassidy, P. Maureen; Cunningham, Margaret C.; Rudin, Susan; Hujer, Andrea M.; Vega, Robert; Furuno, Jon P.; Marshall, Steven H.; Higgins, Paul G.; Jacobs, Michael R.; Wright, Meredith S.; Adams, Mark D.; Bonomo, Robert A.; Pfeiffer, Christopher; Beldavs, Zintars G.

In: Infection control and hospital epidemiology, Vol. 38, No. 11, 01.11.2017, p. 1335-1341.

Research output: Contribution to journalArticle

Buser, GL, Cassidy, PM, Cunningham, MC, Rudin, S, Hujer, AM, Vega, R, Furuno, JP, Marshall, SH, Higgins, PG, Jacobs, MR, Wright, MS, Adams, MD, Bonomo, RA, Pfeiffer, C & Beldavs, ZG 2017, 'Failure to Communicate: Transmission of Extensively Drug-Resistant blaOXA-237-Containing Acinetobacter baumannii - Multiple Facilities in Oregon, 2012-2014', Infection control and hospital epidemiology, vol. 38, no. 11, pp. 1335-1341. https://doi.org/10.1017/ice.2017.189
Buser, Genevieve L. ; Cassidy, P. Maureen ; Cunningham, Margaret C. ; Rudin, Susan ; Hujer, Andrea M. ; Vega, Robert ; Furuno, Jon P. ; Marshall, Steven H. ; Higgins, Paul G. ; Jacobs, Michael R. ; Wright, Meredith S. ; Adams, Mark D. ; Bonomo, Robert A. ; Pfeiffer, Christopher ; Beldavs, Zintars G. / Failure to Communicate : Transmission of Extensively Drug-Resistant blaOXA-237-Containing Acinetobacter baumannii - Multiple Facilities in Oregon, 2012-2014. In: Infection control and hospital epidemiology. 2017 ; Vol. 38, No. 11. pp. 1335-1341.
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title = "Failure to Communicate: Transmission of Extensively Drug-Resistant blaOXA-237-Containing Acinetobacter baumannii - Multiple Facilities in Oregon, 2012-2014",
abstract = "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 blaOXA-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.",
author = "Buser, {Genevieve L.} and Cassidy, {P. Maureen} and Cunningham, {Margaret C.} and Susan Rudin and Hujer, {Andrea M.} and Robert Vega and Furuno, {Jon P.} and Marshall, {Steven H.} and Higgins, {Paul G.} and Jacobs, {Michael R.} and Wright, {Meredith S.} and Adams, {Mark D.} and Bonomo, {Robert A.} and Christopher Pfeiffer and Beldavs, {Zintars G.}",
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T1 - Failure to Communicate

T2 - Transmission of Extensively Drug-Resistant blaOXA-237-Containing Acinetobacter baumannii - Multiple Facilities in Oregon, 2012-2014

AU - Buser, Genevieve L.

AU - Cassidy, P. Maureen

AU - Cunningham, Margaret C.

AU - Rudin, Susan

AU - Hujer, Andrea M.

AU - Vega, Robert

AU - Furuno, Jon P.

AU - Marshall, Steven H.

AU - Higgins, Paul G.

AU - Jacobs, Michael R.

AU - Wright, Meredith S.

AU - Adams, Mark D.

AU - Bonomo, Robert A.

AU - Pfeiffer, Christopher

AU - Beldavs, Zintars G.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - 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 blaOXA-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.

AB - 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 blaOXA-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.

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