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You are Here: Home Page > Guidelines for Infection Control > Infection Control Guidelines for New York State - Nosocomial Acinetobacter Infection  

Infection Control Guidelines for New York State - Nosocomial Acinetobacter Infection

August 1999

Please Distribute To Infection Control, Infectious Disease, Laboratory Director, Quality Assurance, Pharmacy

Re: Nosocomial Acinetobacter Infection

Dear Chief Executive Officer:

I am writing to inform you that the New York State Department of Health has noted an increase in multidrug-resistant Acinetobacter sp. in the New York City metropolitan area. Over the past year, we have been receiving an increasing number of reports of nosocomial clusters caused by Acinetobacter strains that are resistant to many broad spectrum antibiotics. An effective response to preventing further spread of this bacteria will require a multidisciplinary effort. We request your assistance in sharing this letter with the appropriate hospital staff, and ensuring that any increased incidence or outbreak is brought to our attention.

Background

Acinetobacter baumanitii, a gram-negative coccobacillus, has emerged as a significant pathogen in the hospital setting. The organism is fairly stable in the environment and multidrug-resistant strains limit therapeutic options. Before 1997, only one hospital reported a nosocomial outbreak of Acinetobacter to the New York State Department of Health. Since 1997, twelve (12) hospitals have reported significant outbreaks of Acinetobacter infection and a number of other smaller outbreaks are believed to have occurred. Preliminary epidemiologic information provided by the hospitals reveals the following:

• Outbreaks involved an average of 35 patients (range 16-72) and persisted for an average of 7 months (range 1-36).
• Most of the patients who developed infections were in critical care units. No problems were found in pediatric or nursery patients.
• Patients on mechanical ventilation were affected most often.
• Types of infections due to Acinetobacter, varied and included bacteremia, pneumonia, urinary tract and surgical site infections.
• During the course of the outbreaks, the organism tended to become increasingly resistant to antibiotics.
• Half of the hospitals reported that their Acinetobacter strain was highly resistant to antibiotics including imipenem, amikacin and cephalosporin.
• Most of the affected hospitals conducted or arranged for DNA fingerprinting of their Acinetobacter strains. Only two identified a common clone.
• Infection control practices including standard precautions, cohorting where feasible, and decontamination of equipment were reasonably effective in controlling spread.

Recommendations

The characteristics and contributing factors for each nosocomial outbreak are usually different and often require individualized control measures. However, there are some general recommendations that should be considered:

1. Emphasize standard precautions to all clinical staff in the involved unit(s).
2. Conduct laboratory surveillance for Acinetobacter infections, including monitoring trends of antibiotic susceptibility.
3. If an increased incidence of antibiotic resistant Acinetobacter infections is detected, promptly convene an infection control team to develop a control strategy. Representatives from the medical/nursing staff on the involved units, infection control, microbiology, infectious disease and pharmacy should be mobilized for this control team.
4. Consider screening cultures to identify extent of colonization/infection among patients in the involved unit(s).
5. Attempt to cohort colonized or infected patients and staff (including respiratory therapy) where feasible.
6. Ensure appropriate cleaning and disinfection of mechanical ventilators and other respiratory equipment between each patient use.

In addition to the above infection control measures, health care facilities should develop or update antibiotic utilization policies that control antibiotic use as part of an overall strategy to minimize the emergence of multidrug-resistant pathogens.

Reporting

Any significant increase or outbreak of nosocomial infections must be reported to the New York State Department of Health, Nosocomial Reporting Program, by phone (518) 473-4439 or FAX (518) 474-7381, using the enclosed Reporting Form. Epidemiologic consultation and laboratory support is available from both the New York State Department of Health at (518) 473-4439, and the New York City Health Department at (212) 788-9830. Thank you for your cooperation in this important matter.

Sincerely,

Barbara Wallace, M. D.,
Director Bureau of Communicable Disease Control

Enclosure