OutbreaksSunday, May 08, 2011, 13:30 - 14:30
A systematic review of nosocomial outbreaks caused by multidrug-resistant Gram-negative bacteriaE. Zhuchenko, K. Graf*, R.P. Vonberg (Hanover, DE)
Objectives: Multi drug resistant gram negative bacteria (MRGN) represent an increasing problem in many health care setting. Until now there are only few data on sufficient infection control measures that should be applied in the case of an outbreak.
Methods: We conducted a systematic review of the medical literature based on PubMed, the Outbreak Database (www.outbreak-database.com), and on a hand search of so retrieved articles. Pathogens of interest were Acinetobacter spp. (ACI), Pseudomonas spp. (PAE) and ESBL-producing Enterobacteriacea (ESBL). We extracted data on the setting, type of infection, number of patients, duration of the epidemic, and infection control measures.
Results: A total of 59 ACI outbreaks, 109 PAE outbreaks, and 57 ESBL outbreaks were included.
The median duration of the outbreak was 183 days (ACI), 92 days (PAE), and 210 days (ESBL) respectively. The average number of affected patients in the three groups was 25 (ACI outbreaks; thereof infected: 19 patients; thereof died: 4 patients), 23 (PAE; 16; 3), and 57 (ESBL; 46; 2). ACI outbreak specific findings included an association to university hospitals, to intensive care units, and to surgery departments. PAE outbreaks were associated with significantly less use of isolation precautions, less frequently closure of wards, and less use of protective clothing. ESBL outbreaks took place especially in neonatology departments and caused significantly high numbers of urinary tract infections. Additional information on the source of pathogen, its route of transmission, type of infection, age groups of patients, and implemented infection control measures is provided in the table.
Conclusion: The Outbreak Database served as a valuable tool for the characterization of nosocomial outbreaks as several significant differences between the three groups of pathogens examined were detected. Thus, from the findings of the present study we would recommend adjusting the infection control measures specifically on the type of pathogen. However, from our point of view currently there is no MRGN bacterium that should be totally disregarded with this respect.