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Control of a multidrug-resistant Acinetobacter baumannii outbreak

28 February 2019
Volume 28 · Issue 4


This article describes the management of an outbreak of multidrug-resistant Acinetobacter baumannii (MDR-Ab) at an acute NHS Foundation Trust. The outbreak affected two respiratory wards and the initial outbreak lasted 9 months, with the first patient (index case) being identified in April 2015 and the final, tenth case, in September 2015. The outbreak was declared closed in January 2016, but a further two cases were identified in July and August 2016. Of the 12 identified patients, eight were colonised with the bacterium and four were infected. The four infections were of the respiratory tract with MDR-Ab, of identical variable number tandem repeat, isolated from sputum in all cases. All 12 patients were decolonised and this continued throughout the outbreak. Some negative rescreening results were achieved. At the time of the outbreak, decolonisation using octenidine had not been reported in any guidelines. The sensitivity of MDR-Ab to octenidine was microbiologically tested and antibacterial action of octenidine against this organism was demonstrated. The use of octenidine appeared to be one element in helping to control this testing situation. This report seeks to demonstrate not only the complexity of managing and containing an outbreak of MDR-Ab but also how, with the use of a range of effective infection prevention measures, the spread of this pathogen can be successfully controlled. It is hoped that this article will increase awareness among healthcare providers and infection prevention and control (IPC) teams of the threat posed by this organism in the healthcare environment.

The Gram-negative bacterium Acinetobacter baumannii can survive on solid and dry surfaces for up to 5 months and shows a high level of innate and acquired antimicrobial resistance (Nowak and Paluchowska, 2016). Multidrug-resistant Acinetobacter baumannii (MDR-Ab) is an important cause of healthcare infections (Doi et al, 2015; Singh et al, 2015; Nowak and Paluchowska, 2016). It is capable of causing both community- and hospital-acquired infections (HAIs), although HAIs are the most common form (Fournier et al, 2006) and few strains have been recovered from community sources (Antunes et al, 2014).

Recognised as one of the six most important multidrug-resistant microorganisms (MDROs) in hospitals worldwide (Antunes et al, 2014), this pathogen is responsible for a vast array of infections, of which ventilator-associated pneumonia and bloodstream infections are the most common. Mortality rates can reach 35% (Antunes et al, 2014).

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