Outbreak of carbapenem-resistant Pseudomonas aeruginosa infection in a surgical intensive care unit
Summary Infection control personnel performing surveillance activities noticed a cluster of patients with isolates of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in the surgical intensive care unit (SICU) of a German University Hospital. An outbreak investigation including a descriptive analy...
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| Veröffentlicht in: | The Journal of hospital infection 2010-04, Vol.74 (4), p.350-357 |
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| container_title | The Journal of hospital infection |
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| creator | Kohlenberg, A Weitzel-Kage, D van der Linden, P Sohr, D Vögeler, S Kola, A Halle, E Rüden, H Weist, K |
| description | Summary Infection control personnel performing surveillance activities noticed a cluster of patients with isolates of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in the surgical intensive care unit (SICU) of a German University Hospital. An outbreak investigation including a descriptive analysis, a case–control study comparing 15 CRPA case patients with 18 patients with carbapenem-susceptible P. aeruginosa , environmental sampling and pulsed-field gel electrophoresis (PFGE) typing of P. aeruginosa isolates was carried out. Fifteen patients acquired CRPA in the SICU during the outbreak period between 1 July 2006 and 31 October 2006 and PFGE typing of 11 available patient isolates revealed two outbreak strains as well as sporadic CRPA isolates. Both outbreak strains were resistant to penicillins, cephalosporins, carbapenems, aminoglycosides and quinolones, and remained susceptible only to colistin. The most likely mode of transmission was cross-transmission between patients during postoperative wound care with abdominal and/or thoracic drains (odds ratio: 64.33; 95% confidence interval: 5.32–999) and therapy with quinolones (48.37; 3.71–999) being independent risk factors for acquisition of CRPA. No further clusters of CRPA cases were observed after implementation of contact isolation precautions and after healthcare workers were made aware of the likely mode of transmission. This study shows the complex epidemiology of CRPA in a SICU including cross-transmission of two CRPA strains related to postoperative wound care. |
| doi_str_mv | 10.1016/j.jhin.2009.10.024 |
| format | Article |
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An outbreak investigation including a descriptive analysis, a case–control study comparing 15 CRPA case patients with 18 patients with carbapenem-susceptible P. aeruginosa , environmental sampling and pulsed-field gel electrophoresis (PFGE) typing of P. aeruginosa isolates was carried out. Fifteen patients acquired CRPA in the SICU during the outbreak period between 1 July 2006 and 31 October 2006 and PFGE typing of 11 available patient isolates revealed two outbreak strains as well as sporadic CRPA isolates. Both outbreak strains were resistant to penicillins, cephalosporins, carbapenems, aminoglycosides and quinolones, and remained susceptible only to colistin. The most likely mode of transmission was cross-transmission between patients during postoperative wound care with abdominal and/or thoracic drains (odds ratio: 64.33; 95% confidence interval: 5.32–999) and therapy with quinolones (48.37; 3.71–999) being independent risk factors for acquisition of CRPA. No further clusters of CRPA cases were observed after implementation of contact isolation precautions and after healthcare workers were made aware of the likely mode of transmission. This study shows the complex epidemiology of CRPA in a SICU including cross-transmission of two CRPA strains related to postoperative wound care.</description><identifier>ISSN: 0195-6701</identifier><identifier>EISSN: 1532-2939</identifier><identifier>DOI: 10.1016/j.jhin.2009.10.024</identifier><identifier>PMID: 20170982</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Aged ; Aged, 80 and over ; Anti-Bacterial Agents - pharmacology ; Antibacterial agents ; Antibiotics. Antiinfectious agents. 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Drug treatments ; Pseudomonas aeruginosa ; Pseudomonas aeruginosa - drug effects ; Pseudomonas aeruginosa - isolation & purification ; Pseudomonas Infections - epidemiology ; Pseudomonas Infections - microbiology ; Pseudomonas Infections - transmission ; Risk Factors</subject><ispartof>The Journal of hospital infection, 2010-04, Vol.74 (4), p.350-357</ispartof><rights>The Hospital Infection Society</rights><rights>2009 The Hospital Infection Society</rights><rights>2015 INIST-CNRS</rights><rights>Copyright (c) 2009 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c497t-cd131fd21c58764dcd81708ea9d78e264df52d66d573f110dc9ce860f7c3458b3</citedby><cites>FETCH-LOGICAL-c497t-cd131fd21c58764dcd81708ea9d78e264df52d66d573f110dc9ce860f7c3458b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0195670109004940$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22566679$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20170982$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kohlenberg, A</creatorcontrib><creatorcontrib>Weitzel-Kage, D</creatorcontrib><creatorcontrib>van der Linden, P</creatorcontrib><creatorcontrib>Sohr, D</creatorcontrib><creatorcontrib>Vögeler, S</creatorcontrib><creatorcontrib>Kola, A</creatorcontrib><creatorcontrib>Halle, E</creatorcontrib><creatorcontrib>Rüden, H</creatorcontrib><creatorcontrib>Weist, K</creatorcontrib><title>Outbreak of carbapenem-resistant Pseudomonas aeruginosa infection in a surgical intensive care unit</title><title>The Journal of hospital infection</title><addtitle>J Hosp Infect</addtitle><description>Summary Infection control personnel performing surveillance activities noticed a cluster of patients with isolates of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in the surgical intensive care unit (SICU) of a German University Hospital. An outbreak investigation including a descriptive analysis, a case–control study comparing 15 CRPA case patients with 18 patients with carbapenem-susceptible P. aeruginosa , environmental sampling and pulsed-field gel electrophoresis (PFGE) typing of P. aeruginosa isolates was carried out. Fifteen patients acquired CRPA in the SICU during the outbreak period between 1 July 2006 and 31 October 2006 and PFGE typing of 11 available patient isolates revealed two outbreak strains as well as sporadic CRPA isolates. Both outbreak strains were resistant to penicillins, cephalosporins, carbapenems, aminoglycosides and quinolones, and remained susceptible only to colistin. The most likely mode of transmission was cross-transmission between patients during postoperative wound care with abdominal and/or thoracic drains (odds ratio: 64.33; 95% confidence interval: 5.32–999) and therapy with quinolones (48.37; 3.71–999) being independent risk factors for acquisition of CRPA. No further clusters of CRPA cases were observed after implementation of contact isolation precautions and after healthcare workers were made aware of the likely mode of transmission. This study shows the complex epidemiology of CRPA in a SICU including cross-transmission of two CRPA strains related to postoperative wound care.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Antibacterial agents</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Bacterial Typing Techniques</subject><subject>beta-Lactam Resistance</subject><subject>Biological and medical sciences</subject><subject>Carbapenem resistance</subject><subject>Carbapenems - pharmacology</subject><subject>Case-Control Studies</subject><subject>Case–control study</subject><subject>Cluster Analysis</subject><subject>Critical Care</subject><subject>Cross Infection - epidemiology</subject><subject>Cross Infection - microbiology</subject><subject>Cross Infection - transmission</subject><subject>Disease Outbreaks</subject><subject>Electrophoresis, Gel, Pulsed-Field</subject><subject>Environmental Microbiology</subject><subject>General aspects</subject><subject>Germany - epidemiology</subject><subject>Hospitals, University</subject><subject>Human infectious diseases. 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An outbreak investigation including a descriptive analysis, a case–control study comparing 15 CRPA case patients with 18 patients with carbapenem-susceptible P. aeruginosa , environmental sampling and pulsed-field gel electrophoresis (PFGE) typing of P. aeruginosa isolates was carried out. Fifteen patients acquired CRPA in the SICU during the outbreak period between 1 July 2006 and 31 October 2006 and PFGE typing of 11 available patient isolates revealed two outbreak strains as well as sporadic CRPA isolates. Both outbreak strains were resistant to penicillins, cephalosporins, carbapenems, aminoglycosides and quinolones, and remained susceptible only to colistin. The most likely mode of transmission was cross-transmission between patients during postoperative wound care with abdominal and/or thoracic drains (odds ratio: 64.33; 95% confidence interval: 5.32–999) and therapy with quinolones (48.37; 3.71–999) being independent risk factors for acquisition of CRPA. No further clusters of CRPA cases were observed after implementation of contact isolation precautions and after healthcare workers were made aware of the likely mode of transmission. This study shows the complex epidemiology of CRPA in a SICU including cross-transmission of two CRPA strains related to postoperative wound care.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>20170982</pmid><doi>10.1016/j.jhin.2009.10.024</doi><tpages>8</tpages></addata></record> |
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| ispartof | The Journal of hospital infection, 2010-04, Vol.74 (4), p.350-357 |
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| subjects | Aged Aged, 80 and over Anti-Bacterial Agents - pharmacology Antibacterial agents Antibiotics. Antiinfectious agents. Antiparasitic agents Bacterial Typing Techniques beta-Lactam Resistance Biological and medical sciences Carbapenem resistance Carbapenems - pharmacology Case-Control Studies Case–control study Cluster Analysis Critical Care Cross Infection - epidemiology Cross Infection - microbiology Cross Infection - transmission Disease Outbreaks Electrophoresis, Gel, Pulsed-Field Environmental Microbiology General aspects Germany - epidemiology Hospitals, University Human infectious diseases. Experimental studies and models Humans Infectious Disease Infectious diseases Intensive Care Units Male Medical sciences Middle Aged Nosocomial outbreak Pharmacology. Drug treatments Pseudomonas aeruginosa Pseudomonas aeruginosa - drug effects Pseudomonas aeruginosa - isolation & purification Pseudomonas Infections - epidemiology Pseudomonas Infections - microbiology Pseudomonas Infections - transmission Risk Factors |
| title | Outbreak of carbapenem-resistant Pseudomonas aeruginosa infection in a surgical intensive care unit |
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