Biological Health Hazard – Fatal Healthcare-associated Infections (HAI): Acinetobacter – Spain
ACINETOBACTER – SPAIN: (MURCIA) FATAL, INTENSIVE CARE UNIT
Published Date: 2016-09-14 17:09:46
Subject: PRO/EDR> Acinetobacter – Spain: (MU) fatal, ICU
Archive Number: 20160914.4487658
Date: Sun 11 Sep 2016
Source: 20 Minutos, Europa Press report [in Spanish, trans. Sr.Tech.Ed.MJ, edited]
The SMS [Murcia Health Service], under the Ministry of Health, is confident that the molecular analysis of the bacteria detected in the intensive care unit [ICU] of the Virgen de la Arrixaca university clinical hospital will clarify the type and evolution of the outbreak. This was conveyed today [11 Sep 2016] to Francisco Agulló, manager of the SMS, by professionals who are part of the multidisciplinary team that develops the protocol of surveillance and prevention of nosocomial infections.
The SMS manager organized a meeting today [11 Sep 2016] to discuss the situation in the ICU of the Virgen de la Arrixaca university clinical hospital. Participants included the manager of Area I, Juan Antonio Marques, the head of intensive care, Ruben Jara, the shift head and general supervisor, Jose Maria Martinez and Mariano Gomez, respectively. Microbiologist Genoveva Yagüe also participated.
Participants discussed “the evolution of the number of cases, which became noticeable from June and July , when a significant increase was registered,” said the SMS manager. According to statistics, 4 new cases were registered in June, 5 in July, 7 in August, and so far 6 in September, bringing to 22 the number of new cases of “colonization” by acinetobacter. Of these, 11 remain in hospital, 9 of them in the ICU and 2 in the hospital ward.
The health officials insisted that these are patients who are “colonized” by the bacteria, and have not developed any specific clinical manifestation of infection. They also confirmed that in the months preceding the noticeable increase in cases, the number of positive acinetobacter cases remained within the usual parameters for any hospital and emphasized that “the increase in cases and suspected strain change that occurred in June/July led to strengthening of surveillance and control measures.” At the meeting it was determined that within the protocol it is essential to intensify the preventive taking of samples, which in the ICU has gone from once weekly (on Mondays) to 2 per week (on Wednesday and Sunday). In this regard, Agulló stressed that “molecular typing of the strain of the bacteria responsible for colonization is the key to determining the extent of the outbreak and its evolution.”
Other measures to limit the emergence of new cases and eliminate the bacteria in the people infected include the collection of environmental samples (of surfaces and the hands of health care personnel); extreme hygiene measures in health care workers; contact prevention in relatives of patients, and the review and intensification of measures of general hygiene.
Agulló sent a message of reassurance to relatives of patients and users of the Arrixaca hospital, while at the same time adding that “we must be very cautious about the evolution of this outbreak.” Nonetheless, he stressed that “the health service is acting in accordance with the protocols established by scientific societies and we are in the hands of excellent professionals.”
Professionals of the multidisciplinary team also joined this message of calm and recalled that just yesterday [10 Sep 2016] the ICU team held a meeting with each of the families of the affected patients “to provide individualized and detailed information, and explain that this can happen in any hospital.”
Date: Sat 10 Sep 2016
Source: La Verdad [in Spanish, summ. & trans. Sr.Tech.Ed.MJ, edited]
Acinetobacter is one of the bacteria behind the so-called nosocomial infections, which affect 6 per cent of patients admitted to hospitals in the region, according to a study published last April  by the Department of Preventive Medicine of the Reina Sofía Hospital. According to this report, 9000 persons in Murcia acquire such infections each year. The report also concludes that Murcia is the 6th community with the highest incidence of hospital infections, which worsens the national average, but in any case, the study shows an improvement over the years.
The most serious outbreak of a strain of acinetobacter registered in Spain occurred between February 2006 and late 2007 in the Doce de Octubre Hospital in Madrid. According to data available at that time, 252 persons were affected and 18 patients died as a direct consequence of infection by the bacterium, but attributing these deaths to acinetobacter infection was controversial because of contradicting reports within the hospital.
In 2006 there was an outbreak of acinetobacter infection in the ICU of the Reina Sofía Hospital. 3 patients were affected, resulting in their isolation and transfer of the ICU unit to the hospital reanimation area.
[Acinetobacter are aerobic Gram negative coccobacilli commonly found in soil and water and readily survive in a hospital environment. During nosocomial outbreaks, acinetobacter have been recovered from various sites in the patients’ environment, including bed curtains, furniture, and hospital equipment. Of the many _Acinetobacter_ species, _Acinetobacter baumannii_ accounts for about 80 per cent of reported infections.
Outbreaks of acinetobacter infections usually occur in healthcare settings, especially in critically ill patients in intensive care units. These organisms may colonize or cause a variety of infections, such as pneumonia, especially ventilator-associated pneumonia, burn wounds, traumatic and surgical wound infections, bacteremia, urinary tract infections, meningitis, and infective endocarditis. Acinetobacter can spread to susceptible persons by person-to-person contact, contact with contaminated surfaces, or exposure in the environment. Acinetobacter have 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 these organisms.
Acinetobacter infections have been especially a problem for the military wounded in the wars in Iraq and Afghanistan. Most of these isolates were multidrug-resistant. Resistance against broad-spectrum cephalosporins, beta-lactam antibiotics, including the carbapenems, aminoglycosides, and fluoroquinolones is common. _Acinetobacter_ species are unusual in that they are susceptible to the antibacterial property of sulbactam itself, a beta-lactam that is otherwise used for its ability to inhibit certain bacterial beta-lactamases in the beta-lactam/beta-lactamase inhibitor combination drugs, such as ampicillin/sulbactam and cefoperazone/sulbactam. Some isolates are susceptible only to the polymyxins and sulbactam (Go ES, Urban C, Burns J, 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.
Maps of Spain can be seen at http://www.ezilon.com/maps/images/europe/political-map-of-Spain.gif and http://healthmap.org/promed/p/55537.
Murcia is a city in south eastern Spain, the capital and most populous city of the Autonomous Community of the Region of Murcia, and the 7th largest city in the country, with a population of 442 573 residents in 2009 (https://en.wikipedia.org/wiki/Murcia). – Mod.ML]
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