Valencia, RaquelArroyo, Luis AConde, ManuelAldana, Josefa MTorres, María-JoséFernández-Cuenca, FelipeGarnacho-Montero, JoséCisneros, José MOrtíz, CarlosPachón, JerónimoAznar, Javier2014-07-032014-07-032009-03Valencia R, Arroyo LA, Conde M, Aldana JM, Torres MJ, Fernández-Cuenca F, et al. Nosocomial outbreak of infection with pan-drug-resistant Acinetobacter baumannii in a tertiary care university hospital. Infect Control Hosp Epidemiol. 2009 ; 30(3):257-630899-823Xhttp://hdl.handle.net/10668/1672Journal Article;OBJECTIVE To describe what is, to our knowledge, the first nosocomial outbreak of infection with pan-drug-resistant (including colistin-resistant) Acinetobacter baumannii, to determine the risk factors associated with these types of infections, and to determine their clinical impact. DESIGN Nested case-control cohort study and a clinical-microbiological study. SETTING A 1,521-bed tertiary care university hospital in Seville, Spain. PATIENTS Case patients were inpatients who had a pan-drug-resistant A. baumannii isolate recovered from a clinical or surveillance sample obtained at least 48 hours after admission to an intensive care unit (ICU) during the time of the epidemic outbreak. Control patients were patients who were admitted to any of the "boxes" (ie, rooms that partition off a distinct area for a patient's bed and the equipment needed to care for the patient) of an ICU for at least 48 hours during the time of the epidemic outbreak. RESULTS All the clinical isolates had similar antibiotic susceptibility patterns (ie, they were resistant to all the antibiotics tested, including colistin), and, on the basis of repetitive extragenic palindromic-polymerase chain reaction, it was determined that all of them were of the same clone. The previous use of quinolones and glycopeptides and an ICU stay were associated with the acquisition of infection or colonization with pan-drug-resistant A. baumannii. To control this outbreak, we implemented the following multicomponent intervention program: the performance of environmental decontamination of the ICUs involved, an environmental survey, a revision of cleaning protocols, active surveillance for colonization with pan-drug-resistant A. baumannii, educational programs for the staff, and the display of posters that illustrate contact isolation measures and antimicrobial use recommendations. CONCLUSIONS We were not able to identify the common source for these cases of infection, but the adopted measures have proven to be effective at controlling the outbreak.enAcinetobacter baumanniiAntibacterianosInstituciones OncológicasEstudios de Casos y ControlesInfección HospitalariaBrotes de EnfermedadesHospitales UniversitariosHumanosControl de InfeccionesFactores de RiesgoEspañaMedical Subject Headings::Organisms::Bacteria::Gram-Negative Bacteria::Gram-Negative Aerobic Bacteria::Gram-Negative Aerobic Rods and Cocci::Moraxellaceae::Acinetobacter::Acinetobacter baumanniiMedical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial AgentsMedical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospitals::Hospitals, Special::Cancer Care FacilitiesMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Case-Control StudiesMedical Subject Headings::Diseases::Bacterial Infections and Mycoses::Infection::Cross InfectionMedical Subject Headings::Health Care::Environment and Public Health::Public Health::Disease OutbreaksMedical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Academic Medical Centers::Hospitals, Teaching::Hospitals, UniversityMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Health Care::Environment and Public Health::Public Health::Public Health Practice::Communicable Disease Control::Infection ControlMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk FactorsMedical Subject Headings::Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Negative Bacterial Infections::Moraxellaceae Infections::Acinetobacter InfectionsMedical Subject Headings::Geographicals::Geographic Locations::Europe::Spainresearch article19199531open access10.1086/5959771559-6834