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A large sustained endemic outbreak of multiresistant Pseudomonas aeruginosa: a new epidemiological scenario for nosocomial acquisition.
- Source :
-
BMC infectious diseases [BMC Infect Dis] 2011 Oct 13; Vol. 11, pp. 272. Date of Electronic Publication: 2011 Oct 13. - Publication Year :
- 2011
-
Abstract
- Background: Studies of recent hospital outbreaks caused by multiresistant P.aeruginosa (MRPA) have often failed to identify a specific environmental reservoir. We describe an outbreak due to a single clone of multiresistant (MR) Pseudomonas aeruginosa (PA) and evaluate the effectiveness of the surveillance procedures and control measures applied.<br />Methods: Patients with MRPA isolates were prospectively identified (January 2006-May 2008). A combined surveillance procedure (environmental survey, and active surveillance program in intensive care units [ICUs]) and an infection control strategy (closure of ICU and urology wards for decontamination, strict compliance with cross-transmission prevention protocols, and a program restricting the use of carbapenems in the ICUs) was designed and implemented.<br />Results: Three hundred and ninety patients were identified. ICU patients were the most numerous group (22%) followed by urology patients (18%). Environmental surveillance found that 3/19 (16%) non-ICU environmental samples and 4/63 (6%) ICU samples were positive for the MRPA clonal strain. In addition, active surveillance found that 19% of patients were fecal carriers of MRPA. Significant changes in the trends of incidence rates were noted after intervention 1 (reinforcement of cleaning procedures): -1.16 cases/1,000 patient-days (95%CI -1.86 to -0.46; p = 0.003) and intervention 2 (extensive decontamination): -1.36 cases/1,000 patient-days (95%CI -1.88 to -0.84; p < 0.001) in urology wards. In addition, restricted use of carbapenems was initiated in ICUs (January 2007), and their administration decreased from 190-170 DDD/1,000 patient-days (October-December 2006) to 40-60 DDD/1,000 patient-days (January-April 2007), with a reduction from 3.1 cases/1,000 patient-days in December 2006 to 2.0 cases/1,000 patient-days in May 2007. The level of initial carbapenem use rose again during 2008, and the incidence of MRPA increased progressively once more.<br />Conclusions: In the setting of sustained MRPA outbreaks, epidemiological findings suggest that patients may be a reservoir for further environmental contamination and cross-transmission. Although our control program was not successful in ending the outbreak, we think that our experience provides useful guidance for future approaches to this problem.
- Subjects :
- Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents administration & dosage
Anti-Bacterial Agents pharmacology
Carbapenems administration & dosage
Carrier State epidemiology
Carrier State microbiology
Cluster Analysis
Cross Infection microbiology
Endemic Diseases
Female
Genotype
Humans
Incidence
Infection Control methods
Male
Middle Aged
Molecular Typing
Pseudomonas Infections microbiology
Pseudomonas aeruginosa classification
Pseudomonas aeruginosa genetics
Cross Infection epidemiology
Disease Outbreaks
Drug Resistance, Multiple, Bacterial
Pseudomonas Infections epidemiology
Pseudomonas aeruginosa drug effects
Pseudomonas aeruginosa isolation & purification
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2334
- Volume :
- 11
- Database :
- MEDLINE
- Journal :
- BMC infectious diseases
- Publication Type :
- Academic Journal
- Accession number :
- 21995287
- Full Text :
- https://doi.org/10.1186/1471-2334-11-272