Management eines Ausbruchs nosokomialer Pneumonien durch einen neuen multiresistenten Acinetobacter baumannii-Klon[1]

Zusammenfassung

Wir beschreiben Nachweis und Untersuchung eines durch einen multiresistenten Acinetobacter (A.) baumannii-Klon verursachten Ausbruchs auf einer neurologischen Intensivstation am Universitätsklinikum Rostock. Der Keim konnte im Verlauf von 20 Wochen von 7 Patienten isoliert werden, von denen bei 6 eine Pneumonie nachgewiesen werden konnte. Von 24 getesteten Antibiotika war der Keim nur noch gegenüber Colistin sensibel. Eine epidemiologische Untersuchung erbrachte den Nachweis des multiresistenten A. baumannii-Isolats in 13 von 37 Proben von medizinischen Geräten, Bedarfsgegenständen der Patienten und Einrichtungsgegenständen in der Patientenumgebung. Bei der Suche nach der Quelle des Stamms am Klinikum zeigte sich, dass er bereits 3 Jahre zuvor erstmals aufgetreten war und seither vor dem Ausbruch zu sporadischen Infektionen auf internistischen und neurologischen Intensivstationen geführt hatte. Die Identität von allen isolierten Stämmen mit dem neuen Klon konnte mittels Pulsfeldgelelektrophorese (PFGE) und Multilokus-Sequenztypisierung (MLST) nachgewiesen werden. Durch das Hygienepersonal wurde auf der betroffenen Intensivstation ein multimodales Interventionsprogramm eingeleitet. Es umfasste eine konsequente Durchsetzung der Standardhygienemaßnahmen, wiederholte Personalschulungen und situationsadaptierte Desinfektionsprotokolle mit besonderer Betonung der Patientenumgebung. Infolge der Maßnahmen war in Umgebungsproben schließlich kein A. baumannii mehr nachweisbar, sodass der Ausbruch nach 20 Wochen für beendet erklärt werden konnte.

Abstract

We describe the detection and investigation of an outbreak involving a multi-drug-resistant Acinetobacter (A.) baumannii clone in the neurological intensive care unit (ICU) at the University hospital Rostock (Germany). The bacteria were isolated from 7 ICU patients within 20 weeks, six of them showing signs of pneumonia. Among 24 tested antibiotics, the isolates were only susceptible to colistin. An epidemiological investigation revealed the presence of multi-drug-resistant A. baumannii isolates in 13 of 37 samples from medical devices, patient-associated objects and room equipment from the patients’ environment. When investigating the source of this strain in our hospital, we found that it first appeared three years before. Since then it has caused sporadic infections in the medical and neurological ICUs prior to the presented outbreak. The identity of all isolated strains with the novel clone was demonstrated with pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). A multimodal intervention program was introduced by the hygiene staff on the affected ICU. It included consequent enforcement of standard hygiene precautions, repeated staff education and elaborated disinfection protocols specifically addressing the patients’ environment. The procedures led to cessation of A. baumannii detection in environmental samples. Thereafter, the outbreak was cleared within 20 weeks.

1 Ergebnisse dieser Arbeit wurden auf dem 40. Kongress der Deutschen Gesellschaft für Wehrmedizin und Wehrpharmazie e. V. (VDSO) in Bonn (Oktober 2009) vorgestellt.

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1 Ergebnisse dieser Arbeit wurden auf dem 40. Kongress der Deutschen Gesellschaft für Wehrmedizin und Wehrpharmazie e. V. (VDSO) in Bonn (Oktober 2009) vorgestellt.