A large sustained endemic outbreak of multiresistant <it>Pseudomonas aeruginosa</it>: a new epidemiological scenario for nosocomial acquisition

• Main Authors: Sora Mercedes, Gavaldá Laura, Juan Carlos, Tubau Fe, Dominguez M Angeles, Arch Olga, Peña Carmen, Suarez Cristina, Oliver Antonio, Pujol Miquel, Ariza Javier
• Format: Article
• Language: English
• Published: BMC 2011-10-01
• Series: BMC Infectious Diseases
• Online Access: http://www.biomedcentral.com/1471-2334/11/272

<p>Abstract</p> <p>Background</p> <p>Studies of recent hospital outbreaks caused by multiresistant <it>P.aeruginosa </it>(MRPA) have often failed to identify a specific environmental reservoir. We describe an outbreak due to a single clone of multiresistant (MR) <it>Pseudomonas aeruginosa </it>(PA) and evaluate the effectiveness of the surveillance procedures and control measures applied.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusions</p> <p>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.</p>