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KMID : 0829320140170020029
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Korean Journal of Clinical Microbiology
2014 Volume.17 No. 2 p.29 ~ p.34
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Characterization of the Multidrug-Resistant Acinetobacter species Causing a Nosocomial Outbreak at Intensive Care Units in a Korean Teaching Hospital: Suggesting the Correlations with the Clinical and Environmental Samples, Including Respiratory Tract-related Instruments
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Chung Hae-Sun
Lee Yang-Soon
Park Eun-Suk
Lee Dong-Suk
Ha Eun-Jin
Kim Myung-Sook
Yong Dong-Eun
Jeong Seok-Hoon
Lee Kyung-Won
Chong Yun-Sop
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Abstract
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Background: Acinetobacter spp. is an important nosocomial pathogen for which increasing resistance to
multiple antimicrobial agents has been observed. Prevalence of multidrug-resistant (MDR) Acinetobacter spp. in the intensive care unit (ICU) at a teaching hospital in Korea started to increase in 2008. The aim of this study was to determine the source of pathogen spread and to characterize the emerging strains at an early stage of outbreak.
Methods: Samples from respiratory instruments and fomites in the ICUs, as well as from the healthcare
workers, were cultured to identify the sources of MDR Acinetobacter spp. Antimicrobial susceptibility was determined by the CLSI disk diffusion method. Pulsed field gel electrophoresis (PFGE) was performed for clinical and environmental isolates in order to determine clonality. Carbapenemase genes were detected by multiplex PCR. Infection control
measures including peer-monitoring of hand washing, environmental cleaning and standard precautions were enforced.
Results: Among the samples from the ICU tools (105) and healthcare worker’s hands (44), 31 (30%) and 2 (5%) respective samples yielded MDR Acinetobacter spp. Among the environmental samples, 90% were from respiratory-related equipment. The majority of clinical and environmental MDR Acinetobacter spp. (44/55) belonged to the pulsotype A. aumannii and carried both blaOXA-51-like and blaOXA-23-like genes. Even though infection-control measures were enforced, prevalence of MDR Acinetobacter spp. continues to increase.
Conclusion: An outbreak of MDR Acinetobacter spp. in a Korean hospital was caused by A. baumannii
carrying the blaOXA-23-gene and was correlated with contaminated respiratory-related instruments in the
ICUs. More intensive measures for nosocomial infection control are needed for successful prevention of Acinetobacter spread in hospitals.
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KEYWORD
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Acinetobacter, Beta-lactamase OXA-23, Infection control, Disease outbreaks
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