Open AccessHigh mortality in an outbreak of multidrug resistant Acinetobacter baumannii infection introduced to an oncological hospital by a patient transferred from a general hospital
Author(s) -
Patricia CornejoJuárez,
Miguel A. Cevallos,
Semiramis Castro-Jaimes,
Santiago Castillo-Ramírez,
Consuelo Velázquez-Acosta,
David H Martínez-Oliva,
Ángeles Pérez-Oseguera,
Frida RiveraBuendía,
Patricia Volkow-Fernández
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0234684
Subject(s) - acinetobacter baumannii , outbreak , multilocus sequence typing , epidemiology , molecular epidemiology , medicine , multiple drug resistance , isolation (microbiology) , typing , plasmid , microbiology and biotechnology , biology , antibiotics , genotype , virology , pseudomonas aeruginosa , genetics , bacteria , dna , gene
Objective To describe the clinical features, outcomes, and molecular epidemiology of an outbreak of multidrug resistant (MDR) A . baumannii . Methods We performed a retrospective analysis of all MDR A . baumannii isolates recovered during an outbreak from 2011 to 2015 in a tertiary care cancer hospital. Cases were classified as colonized or infected. We determined sequence types following the Bartual scheme and plasmid profiles. Results There were 106 strains of A . baumannii isolated during the study period. Sixty-six (62.3%) were considered as infection and 40 (37.7%) as colonization. The index case, identified by molecular epidemiology, was a patient with a drain transferred from a hospital outside Mexico City. Ninety-eight additional cases had the same MultiLocus Sequence Typing (MLST) 758, of which 94 also had the same plasmid profile, two had an extra plasmid, and two had a different plasmid. The remaining seven isolates belonged to different MLSTs. Fifty-three patients (50%) died within 30 days of A . baumanniii isolation: 28 (20%) in colonized and 45 (68.2%) in those classified as infection (p<0.001). In multivariate regression analysis, clinical infection and patients with hematologic neoplasm, predicted 30-day mortality. The molecular epidemiology of this outbreak showed the threat posed by the introduction of MDR strains from other institutions in a hospital of immunosuppressed patients and highlights the importance of adhering to preventive measures, including contact isolation, when admitting patients with draining wounds who have been hospitalized in other institutions.