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Published Date: 2012-06-29 09:32:30
Subject: PRO/EDR> Acinetobacter - Chile: (Santiago) burn unit, drug-resistant
Archive Number: 20120629.1184441

ACINETOBACTER - CHILE: (SANTIAGO) BURN UNIT, DRUG-RESISTANT
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Date: Wed 27 Jun 2012
Source: La Nacion (Chile) [in Spanish, trans., Sr.Tech.Ed.MJ, edited]
http://www.lanacion.cl/posta-central-confirman-nuevos-contagios-de-bacteria-multiresistente/noticias/2012-06-27/174222.html

Authorities from the Public Assistance Hospital (former Central Hospital [located in Santiago, Chile]), reported this Wed 27 Jun 2012 that 8 cases of _Acinetobacter baumannii_ have been detected in patients in the Burn Unit.

The infections were confirmed Wednesday [27 Jun 2012] by the hospital director, Emilio Villalon, who reported that the infected persons are older than 60 years of age. The new infectious agent had already been detected in April [2012], when an outbreak of _Clostridium difficile_ was reported.

The hospital director said the situation has been controlled and appropriate preventive measures have been implemented. He indicated that the bacterium is multiresistant to antibiotics and affects immunocompromised patients.

Dr Ricardo Peña, president of the Posta Central [Central Hospital] Doctors Association, said that authorities have recognized that there is an outbreak of infection and that the appropriate measures are being taken.

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[_Acinetobacter baumannii_ has emerged as a significant multidrug-resistant nosocomial pathogen. Burns patients, especially those with severe burn wounds, are highly susceptible to infection with this organism (http://surgery.uthscsa.edu/faculty/pubs/acinetobacter.pdf), which has caused outbreaks in burn units (http://cid.oxfordjournals.org/content/29/5/1358.2.full and http://www.ncbi.nlm.nih.gov/pubmed/12781606). However, the news report above fails to state if the cases of nosocomial multidrug-resistant acinetobacter infection were clustered in time or location within the hospital, if DNA fingerprinting of the clinical isolates was done, and if any of the clinical isolates proved to have identical genotypes.

The following has been extracted from moderator ML comments in ProMED-mail post Acinetobacter, resistant, fatal - Japan: (Tokyo) RFI 20100907.3203:

Infection due to multidrug-resistant acinetobacter strains, especially _Acinetobacter baumannii_ (MDR-Ab), in critically ill, hospitalized patients and the frequency of clonal nosocomial outbreaks due to these microorganisms has increased worldwide in the past several decades (see: Urban C, et al: Considerations in control and treatment of nosocomial infections due to multidrug-resistant _Acinetobacter baumannii_. Clin Infect Dis. 2003; 36(10): 1268-74; available at http://www.journals.uchicago.edu/doi/full/10.1086/374847).

MDR-Ab have also been reported recently to cause infections after natural disasters (see http://www-nehc.med.navy.mil/downloads/prevmed/acinetobacter_100208.pdf) and in soldiers severely injured in the war in Iraq.

During nosocomial outbreaks, MDR-Ab have been recovered from various sites in the patients' environment, including bed curtains, furniture, and hospital equipment. MDR-Ab has been reported to spread most commonly on the hands of hospital personnel from the contaminated environment or from patients who are either infected or colonized with MDR-Ab.

Resistance to multiple commonly used antibiotics, including penicillins, carbapenems, cephalosporins, monobactams, aminoglycosides, and fluoroquinolones, severely restricts treatment options for infections caused by MDR-Ab. The mechanisms of antibiotic resistance in MDR-Ab include various aminoglycoside inactivating enzymes, plasmid-mediated, and/or chromosomal-linked beta-lactamases that inactivate beta-lactam antibiotics, alteration of targets for antimicrobial drugs such as the penicillin-binding proteins, and antibiotic efflux pumps; these mechanisms are at times combined with absent or reduced expression of porin channels that limit penetration of antibiotics to their site of action (see: Dijkshoorn L, et al: An increasing threat in hospitals: multidrug-resistant _Acinetobacter baumannii_. Nat Rev Microbiol. 2007; 5(12): 939-51; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18007677).

Some isolates are susceptible only to the polymyxins and sulbactam (Go ES, Urban C, et al: Clinical and molecular epidemiology of _Acinetobacter_ infections sensitive only to polymyxin B and sulbactam. Lancet North Am Ed. 1994; 344(8933): 1329-32; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/7968028), although resistance to these antibiotics has also been reported.

Attempts to reduce the frequency of nosocomial infections due to MDR-Ab have involved surveillance and restriction of antibiotic use and enhanced infection control interventions (see: Urban C, et al (2003): reference above).

Santiago and the Posta Central Hospital may be located on the HealthMap/ProMED-mail interactive map at http://healthmap.org/r/2F9H. - Mod.ML]

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