Carbapenem-resistant Acinetobacter baumannii Outbreak in a COVID-19 Isolation Ward and Successful Outbreak Control with Infection Control Measures
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Background Even amid the coronavirus disease-19 (COVID-19) pandemic, the spread of multidrug-resistant bacteria and infection control are still important tasks. After recognizing the carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak that occurred in the isolation room for COVID-19, we would like to introduce what infection control measures were implemented to eradicate it. Materials and Methods All COVID-19 patients with CRAB in any specimen admitted to the COVID-19 isolation ward of the tertiary hospital in Korea from October to November 2021 were analyzed. Results During the outbreak, 23 patients with COVID-19 and CRAB infections were identified. The index case was an 85-year-old female referred from a long-term care facility. CRAB was identified in sputum culture in most patients (91.3%). The CRAB outbreak occurred mainly in the rooms around the index case. Environmental cultures on the floor, air inlet, air outlet, and window frame of the rooms were performed. The antimicrobial resistance patterns of CRAB from patients and the environment were identical; whole-genome sequencing analyses revealed isolated clonality. Infection control measures with enhanced environmental cleaning using 1,000 ppm sodium hypochlorite and phenolic compounds, enhanced hand hygiene, additional education, and mandatory additional gowning and gloving of COVID-19 personal protective equipment (PPE) were applied on 29 October. No CRAB infection cases occurred from 2 November for two weeks. Conclusion In addition to applying PPE and COVID-19 precautions in COVID-19 isolation wards, adhering to strict contact precautions along with environmental control can help prevent the spread of multidrug-resistant bacteria.
Abstract
Background Even amid the coronavirus disease-19 (COVID-19) pandemic, the spread of multidrug-resistant bacteria and infection control are still important tasks. After recognizing the carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak that occurred in the isolation room for COVID-19, we would like to introduce what infection control measures were implemented to eradicate it. Materials and Methods All COVID-19 patients with CRAB in any specimen admitted to the COVID-19 isolation ward of the tertiary hospital in Korea from October to November 2021 were analyzed. Results During the outbreak, 23 patients with COVID-19 and CRAB infections were identified. The index case was an 85-year-old female referred from a long-term care facility. CRAB was identified in sputum culture in most patients (91.3%). The CRAB outbreak occurred mainly in the rooms around the index case. Environmental cultures on the floor, air inlet, air outlet, and window frame of the rooms were performed. The antimicrobial resistance patterns of CRAB from patients and the environment were identical; whole-genome sequencing analyses revealed isolated clonality. Infection control measures with enhanced environmental cleaning using 1,000 ppm sodium hypochlorite and phenolic compounds, enhanced hand hygiene, additional education, and mandatory additional gowning and gloving of COVID-19 personal protective equipment (PPE) were applied on 29 October. No CRAB infection cases occurred from 2 November for two weeks. Conclusion In addition to applying PPE and COVID-19 precautions in COVID-19 isolation wards, adhering to strict contact precautions along with environmental control can help prevent the spread of multidrug-resistant bacteria.
참고문헌 (29)
- Witt LS, "The impact of COVID-19 on multidrug-resistant organisms causing healthcare-associated infections : a narrative review", JAC Antimicrob Resist, 5, pp.dlac130~ (2022)
- Son HJ, "Risk factors for isolation of multi-drug resistant organisms in coronavirus disease 2019 pneumonia : a multicenter study", Am J Infect Control, 49, pp.1256~1261 (2021)
- Sharma A, "Multi-country cross-sectional study of colonization with multidrug-resistant organisms : protocol and methods for the Antibiotic Resistance in Communities and Hospitals(ARCH)studies", BMC Public Health, 21, pp.1412~ (2021)
- Dickstein Y, "Carbapenem-resistant Enterobacteriaceae colonization and infection in critically ill patients : a retrospective matched cohort comparison with non-carriers", J Hosp Infect, 94, pp.54~59 (2016)
- Tischendorf J, "Risk of infection following colonization with carbapenem-resistant Enterobactericeae : a systematic review", Am J Infect Control, 44, pp.539~543 (2016)
- Cole J, "The impact of the COVID-19 pandemic on healthcare acquired infections with multidrug resistant organisms", Am J Infect Control, 49, pp.653~654 (2021)
- Sun Jin L, "MDRO transmission in acute hospitals during the COVID-19 pandemic", Curr Opin Infect Dis, 34, pp.365~371 (2021)
- Wong SC, "Air dispersal of multidrug-resistant Acinetobacter baumannii : implications for nosocomial transmission during the COVID-19 pandemic", J Hosp Infect, 116, pp.78~86 (2021)
- Shinohara DR, "Outbreak of endemic carbapenem-resistant Acinetobacter baumannii in a coronavirus disease 2019(COVID-19)-specific intensive care unit", Infect Control Hosp Epidemiol, 43, pp.815~817 (2022)
- Sharifipour E, "Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU", BMC Infect Dis, 20, pp.646~ (2020)
- Perez S, "Increase in hospital-acquired carbapenem-resistant Acinetobacter baumannii infection and colonization in an acute care hospital during a surge in COVID-19 admissions-New Jersey, February-July 2020", MMWR Morb Mortal Wkly Rep, 69, pp.1827~1831 (2020)
- Lee K, "Multidrug-resistant Acinetobacter spp. : increasingly problematic nosocomial pathogens", Yonsei Med J, 52, pp.879~891 (2011)
- Wang L, "Coronavirus disease 2019 in elderly patients : characteristics and prognostic factors based on 4-week follow-up", J Infect, 80, pp.639~645 (2020)
- Peleg AY, "Acinetobacter baumannii : emergence of a successful pathogen", Clin Microbiol Rev, 21, pp.538~582 (2008)
- Nutman A, "Evaluation of carriage and environmental contamination by carbapenem-resistant Acinetobacter baumannii", Clin Microbiol Infect, 22, pp.949~ (2016)
- Tacconelli E, "ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients", Clin Microbiol Infect, 20(Suppl 1), pp.1~55 (2014)
- "Guideline for isolation precautions" (2020)[URL]
- "Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages"[URL]
- Clinical and Laboratory Standard Institute (CLSI), "Performance standards for antimicrobial susceptibility testing; Twenty-Fifth informational supplement", pp.132~135 (2015), CLSI
- Viehman JA, "Treatment options for carbapenem-resistant and extensively drug-resistant Acinetobacter baumannii infections", Drugs, 74, pp.1315~1333 (2014)
- Katip W, "Short versus long course of colistin treatment for carbapenem-resistant A. baumannii in critically ill patients : a propensity score matching study", J Infect Public Health, 16, pp.1249~1255 (2023)
- Katip W, "Clinical efficacy and nephrotoxicity of the loading dose colistin for the treatment of carbapenem-resistant Acinetobacter baumannii in critically ill patients", Pharmaceutics, 14, pp.31~ (2021)
- Katip W, "Effectiveness and nephrotoxicity of loading dose colistin-meropenem versus loading dose colistin-imipenem in the treatment of carbapenem-resistant Acinetobacter baumannii infection", Pharmaceutics, 14, pp.1266~ (2022)
- Russo A, "Multidrug-resistant Acinetobacter baumannii infections in COVID-19 patients hospitalized in intensive care unit", Infection, 50, pp.83~92 (2022)
- Dharan S, "Routine disinfection of patients’ environmental surfaces. Myth or reality?", J Hosp Infect, 42, pp.113~117 (1999)
- Traverse M, "Environmental cleaning and disinfection", Vet Clin North Am Small Anim Pract, 45, pp.299~330 (2015)
- Leas BF, "Environmental cleaning for the prevention of healthcare-associated infections" (2015), Agency for Healthcare Research and Quality
- Denton M, "Role of environmental cleaning in controlling an outbreak of Acinetobacter baumannii on a neurosurgical intensive care unit", J Hosp Infect, 56, pp.106~110 (2004)
- Kim D, "Current status of multidrug-resistant bacteria", J Korean Med Assoc, 65, pp.468~477 (2022)