Infection Control & Hospital Epidemiology
the studies. First, the rate of individual adverse events between the MRSA/VRE and non-MRSA/VRE patients in Martin et al are not included. Second, for rate calculation, we calculated the rate per 1,000 patient days, whereas Martin et al considered the rate per 1,000 admissions.Whether thishadany influenceonoutcomes isunknown. Similar to the previous study by Martin et al3 that indicated no
change in the healthcare associated infection (HAI) rates of MRSA/VRE after elimination of CP, we also reported no sig- nificant change in HAI rates in MRSA/VRE patients after elim- inating CP in our study.2 Thus, eliminating CP for MRSA/VRE patients is not associated with increased HAI rates with MRSA/ VRE and could improve patient safety outcomes. Our observation that MRSA/VRE patients are at higher risk of noninfectious adverse events argues the need for serious consideration of eliminating CP among MRSA/VRE patients.
Acknowledgments.
1273 Financial support. No financial support was provided relevant to this article.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
References
1. Martin EM, Bryant B, Grogan TR, et al. Noninfectious hospital adverse events decline after elimination of contact precautions for MRSA and VRE. Infect Control Hosp Epidemiol
2018.Published online May10, 2018,p.1–9.
2. Gandra S, Barysauskas C, Mack DA, Barton B, Finberg R, Ellison RT III. Impact of contact precautions on falls, pressure ulcers and transmission of MRSA and VRE in hospitalized patients. JHosp Infect 2014; 88:170–176.
3. Martin EM, Russell D, Rubin Z, et al. Elimination of routine contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: a retrospective quasi-experimental study. Infect Control Hosp Epidemiol 2016; 37:1323–1330.
Collaboration for containment: Detection of OXA-23–like carbapenamase-producing Acinetobacter baumannii in Colorado
Heather L. Young MD1, Caroline Croyle MPH2, Sarah J. Janelle MPH, CIC3, Bryan C. Knepper MPH, MSc, CIC2, Jennifer Kurtz BSN, MS2, Amber Miller MSN, CIC, CHFM4, Sara M. Reese PhD, MPH, CIC5, Kyle Schutz MSc3 and
Wendy M. Bamberg MD3 1Department of Medicine, Denver Health Medical Center and University of Colorado School of Medicine, Denver, Colorado, 2Department of Patient Safety and Quality, Denver Health Medical Center, Denver, Colorado, 3Colorado Department of Public Health and Environment, Denver, Colorado, 4Department of Planning and Construction, University of Colorado Health, Aurora, Colorado and 5Department of Quality. Swedish Medical Center, Denver, Colorado
To the Editor—Multidrug-resistant Acinetobacter baumannii (MDR-AB) is an aggressive pathogen often transmitted in healthcare facilities. Critically ill patients are at highest risk, particularly those with recent surgery, prolonged ventilation, and exposure to broad spectrum antibiotics.1 Containment of MDR- AB requires early identification and multifaceted interventions. MDR-AB strains that are resistant to carbapenems present
additional containment issues because plasmid-mediated carba- penemase production is a common resistance mechanism.2 Given its importance as an emerging antimicrobial-resistant pathogen, many public health departments, including the Denver metro- politan region in Colorado, require carbapenem-resistant Acine- tobacter baumannii (CRAB) to be reported. Between December 2017 and February 2018, Denver Health
Medical Center (DHMC) detected 2 inpatients with carbapenemase- producing CRAB isolates in urine. Prior to these cases, no previous CRAB isolates in Colorado had been characterized as carbapenemase-producing organisms. DHMC and the Colorado Department of Public Health and Environment (CDPHE) collabo- rated to determine epidemiologic and molecular relatedness of the
Author for correspondence: Heather Young MD, Denver Health Medical Center, 601
Broadway, MC 4000, Denver CO 80204. E-mail:
Heather.Young2@
dhha.org ADDITIONAL PRESENTATION. This work has been accepted as a poster abstract at the ID Week conference in San Francisco, California, in October 2018.
Cite this article: Young HL. et al. (2018). Collaboration for containment: Detection of
OXA-23–like carbapenamase-producing Acinetobacter baumannii in Colorado. Infection Control & Hospital Epidemiology. 2018, 39, 1273–1274. doi: 10.1017/ice.2018.202
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
isolates, as well as to investigate healthcare infection control measures. DHMC is a 555-bed safety net teaching hospital and level 1
trauma center located in Denver, Colorado. DHMC previously reported an MDR-AB outbreak between 2004 and 2005,3 and these MDR-AB isolates retained carbapenem susceptibility. Regionally, CRAB is unusual in the Denver metropolitan region, with 2–13 cases reported from sterile body sites and urine per year since 2013. The CDPHE epidemiologists and DHMC infection preven-
tionists performed surveillance for additional cases that met the case definition. CRAB isolates were defined as those that had a mini- mum inhibitory concentration (MIC) to at least 1 carbapenem in the intermediate or resistant range. Investigators reviewed medical records for common hospital locations, medical equipment, pro- cedures, and staff members. Infection preventionists observed practices among shared staff members. Pulsed-field gel electro- phoresis (PFGE) was performed at the CDPHE laboratory, while antimicrobial susceptibility and carbapenemase testing was per- formed at the Centers for Disease Control and Prevention (CDC). The epidemiologic investigation revealed several similarities.
Patient 1 was a 59-year-old male with diabetes mellitus and spina bifida, while patient 2 was a 23-year-old male with lym- phangiomatosis and resulting T6 paraplegia. Both patients had neurogenic bladders managed by suprapubic catheters, stage 4 decubitus ulcers, recent surgery, and extensive antibiotic exposure. Neither had recently traveled outside of Colorado nor received a carbapenem in the prior 6 months. CRAB was detected from urine
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