TY - JOUR
T1 - Molecular epidemiology, microbiological features and infection control strategies for carbapenem-resistant Acinetobacter baumannii in a German burn and plastic surgery center (2020-2022)
AU - Vital, Marius
AU - Woltemate, Sabrina
AU - Schlüter, Dirk
AU - Krezdorn, Nicco
AU - Dieck, Thorben
AU - Dastagir, Khaled
AU - Bange, Franz-Christoph
AU - Ebadi, Ella
AU - Vogt, Peter M
AU - Knegendorf, Leonard
AU - Baier, Claas
N1 - © 2024. The Author(s).
PY - 2024/9/6
Y1 - 2024/9/6
N2 - BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) frequently causes both healthcare-associated infections and nosocomial outbreaks in burn medicine/plastic surgery and beyond. Owing to the high antibiotic resistance, infections are difficult to treat, and patient outcomes are often compromised. The environmental persistence capability of CRAB favors its transmission in hospitals. A comprehensive analysis and understanding of CRAB epidemiology and microbiology are essential for guiding management.METHODS: A three-year retrospective cohort study (2020-2022) was conducted in a German tertiary burn and plastic surgery center. In addition to epidemiological analyses, microbiological and molecular techniques, including whole-genome sequencing, were applied for the comprehensive examination of isolates from CRAB-positive patients.RESULTS: During the study period, eight CRAB cases were found, corresponding to an overall incidence of 0.2 CRAB cases per 100 cases and an incidence density of 0.35 CRAB cases per 1000 patient-days. Six cases (75%) were treated in the burn intensive care unit, and four cases (50%) acquired CRAB in the hospital. Molecular analyses comprising 74 isolates supported the epidemiologic assumption that hospital acquisitions occurred within two separate clusters. In one of these clusters, environmental CRAB contamination of anesthesia equipment may have enabled transmission. Furthermore, molecular diversity of CRAB isolates within patients was observed.CONCLUSIONS: CRAB can pose a challenge in terms of infection prevention and control, especially if cases are clustered in time and space on a ward. Our study demonstrates that high-resolution phylogenetic analysis of several bacterial isolates from single patients can greatly aid in understanding transmission chains and helps to take precision control measures.
AB - BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) frequently causes both healthcare-associated infections and nosocomial outbreaks in burn medicine/plastic surgery and beyond. Owing to the high antibiotic resistance, infections are difficult to treat, and patient outcomes are often compromised. The environmental persistence capability of CRAB favors its transmission in hospitals. A comprehensive analysis and understanding of CRAB epidemiology and microbiology are essential for guiding management.METHODS: A three-year retrospective cohort study (2020-2022) was conducted in a German tertiary burn and plastic surgery center. In addition to epidemiological analyses, microbiological and molecular techniques, including whole-genome sequencing, were applied for the comprehensive examination of isolates from CRAB-positive patients.RESULTS: During the study period, eight CRAB cases were found, corresponding to an overall incidence of 0.2 CRAB cases per 100 cases and an incidence density of 0.35 CRAB cases per 1000 patient-days. Six cases (75%) were treated in the burn intensive care unit, and four cases (50%) acquired CRAB in the hospital. Molecular analyses comprising 74 isolates supported the epidemiologic assumption that hospital acquisitions occurred within two separate clusters. In one of these clusters, environmental CRAB contamination of anesthesia equipment may have enabled transmission. Furthermore, molecular diversity of CRAB isolates within patients was observed.CONCLUSIONS: CRAB can pose a challenge in terms of infection prevention and control, especially if cases are clustered in time and space on a ward. Our study demonstrates that high-resolution phylogenetic analysis of several bacterial isolates from single patients can greatly aid in understanding transmission chains and helps to take precision control measures.
KW - Acinetobacter baumannii/genetics
KW - Humans
KW - Acinetobacter Infections/epidemiology
KW - Germany/epidemiology
KW - Carbapenems/pharmacology
KW - Retrospective Studies
KW - Male
KW - Female
KW - Middle Aged
KW - Cross Infection/epidemiology
KW - Aged
KW - Adult
KW - Infection Control/methods
KW - Molecular Epidemiology
KW - Anti-Bacterial Agents/pharmacology
KW - Burns/microbiology
KW - Surgery, Plastic
KW - Burn Units
KW - Whole Genome Sequencing
KW - Incidence
KW - Microbial Sensitivity Tests
U2 - 10.1186/s13756-024-01459-5
DO - 10.1186/s13756-024-01459-5
M3 - Article
C2 - 39242542
SN - 2047-2994
VL - 13
JO - Antimicrobial Resistance and Infection Control
JF - Antimicrobial Resistance and Infection Control
IS - 1
M1 - 99
ER -