Identifier to cite or link to this item: http://hdl.handle.net/20.500.13003/13239
A large sustained endemic outbreak of multiresistant Pseudomonas aeruginosa: a new epidemiological scenario for nosocomial acquisition
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eISSN: 1471-2334
WOS ID: 000296357600001
Scopus EID: 2-s2.0-80053892799
PMID: 21995287
Embase PUI: L51670548
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2011-10-13Document type
research articleCitation
Suarez C, Pena C, Arch O, Dominguez MA, Tubau F, Juan C, et al. A large sustained endemic outbreak of multiresistant Pseudomonas aeruginosa: a new epidemiological scenario for nosocomial acquisition. BMC Infect Dis. 2011 Oct 13;11:272.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. 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. 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. 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.
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https://dx.doi.org/10.1186/1471-2334-11-272MeSH
Endemic DiseasesInfection Control
Aged, 80 and over
Genotype
Aged
Cluster Analysis
Carbapenems
Drug Resistance, Multiple, Bacterial
Adult
Anti-Bacterial Agents
Cross Infection
Humans
Middle Aged
Carrier State
Male
Disease Outbreaks
Female
Pseudomonas aeruginosa
Incidence
Molecular Typing
Pseudomonas Infections
DeCS
IncidenciaFarmacorresistencia Bacteriana Múltiple
Femenino
Brotes de Enfermedades
Masculino
Tipificación Molecular
Portador Sano
Humanos
Persona de Mediana Edad
Anciano
Infección Hospitalaria
Genotipo
Anciano de 80 o más Años
Control de Infecciones
Infecciones por Pseudomonas
Adulto
Pseudomonas aeruginosa
Antibacterianos
Carbapenémicos
Análisis por Conglomerados
Enfermedades Endémicas