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Background  We aimed to determine the prevalence of colonization by multidrug-resistant Gram-negative bacteria including ESBL-producing enterobacteriaceae, carbapenem-resistant enterobacteriaceae,  Pseudomonas aeruginosa  and  Acinetobacter baumannii  at two wards caring long term for patients with disorder of consciousness at the Geriatric Health Centers Graz, Austria. During our study we detected two  A. baumannii  outbreaks.    Methods  In August 2015, we conducted a point-prevalence study. Inguinal and perianal swabs were taken from 38 patients and screened for multidrug-resistant Gram-negative rods using standard procedures. Six months after the initial investigation all patients were sampled again and use of antibiotics during the past 6 months and mortality was registered. Genetic relatedness of bacteria was evaluated by DiversiLab system.    Results  Fifty percent of patients were colonized by multidrug-resistant Gram-negative isolates. Five patients harboured ESBL-producing enterobacteriaceae. No carbapenem-resistant enterobacteriaceae were detected. 13/38 patients were colonized by  A. baumannii  isolates (resistant to ciprofloxacin but susceptible to carbapenems). There was a significant difference in the prevalence of colonization by  A. baumannii  between ward 2 and ward 1 (60% vs. 5.6%,  p  < 0.001). Two clusters of  A. baumannii  isolates were identified including one isolate detected on a chair in a patient’s room.    Conclusions  We detected a high prevalence of two multidrug-resistant  A. baumannii  strains in patients with disorder of consciousness at a LTCF in Graz, Austria. Our findings strongly suggest nosocomial cross-transmission between patients. An active surveillance strategy is warranted to avoid missing newly emerging pathogens.

Colonization of long term care facility patients with MDR-Gram-negatives during an Acinetobacter baumannii outbreak