Role of tigecycline in the control of outbreak of carbapenem-resistant Acinetobacter baumannii infections in an intensive care unit, Kuwait
Abstract number: P795
Rotimi V., Jamal W., Salama M.I., El-Din K., Dehrab N.
Objective: To report 3 different episodes of nosocomial outbreaks of multi-resistant Acinetobacter baumannii (MRAB) infections in an ICU setting, successfully controlled with tigecycline.
Methods: The outbreaks of Acinetobacter infections occurred in February and April, 2006 and April 2007. Patients' ages, nationality, underlying co-morbidities, prior antibiotics used, site of infection, major reason for hospital admission, whether or not ventilated and length of ICU stay, were recorded. Samples of endotracheal tube (ET) secretions, sputum, blood, urine, CSF and wound were collected and cultured on appropriate bacteriological media. The isolates were identified using automated VITEK 2 ID system and the API 20NE system. Susceptibility testing was done by the Etest method. Molecular typing of the isolates was determined by PFGE. Patient and environmental screening strategies previously agreed to by the Outbreak Management Committee were carried out. Patients were nursed in isolation rooms or single side rooms.
Results: A total 21 patients, aged 1975 years, were involved. Time of admission to time of acquiring infection ranged from 331 days. All isolates were resistant to 1517 antibiotics, including carbapenems (MRAB-C) but susceptibile to tigecycline with MIC90 of 2 mg/ml. Overall mortality rate was 14.3%. The first outbreak involved 6 cases with pnuemonia, meningitis and UTI. Time to clearance of the MRAB-C after therapy with amikacin and ciprofloxacin was 8.3 days and was associated with a mortality rate of 50%; tigecycline was unavailable for use at this time. The second outbreak involved 10 patients (6 bacteraemias, 3 pneumonia and 1 UTI). All patients received tigecycline in adequate doses. Time to clearance was 2.8 days and all survived. Five patients (3 bacteraemias, 1 pneumonia and 1 abscess), were involved in the third outbreak. They were also treated with tigecycline. Time to clearance was 3.1 days and all survived. Environmental screening revealed gross contamination of many surfaces and equipment within the unit. Genotypic characteristics demonstrated 2 distinct clonal strains. Other measures included closure of the ICU to new admissions during the second outbreak to allow for adequate cleaning and disinfection of the unit.
Conclusion: Two clones of MRAB-C were responsible for the outbreaks and successful control included the use of tigecycline and aggressive infection control strategies.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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