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Outbreak of carbapenem-resistant Acinetobacter baumannii carrying the carbapenemase OXA-23 in a German university medical centre

Anke Kohlenberg^1,, Sophie Brümmer¹, Paul G. Higgins², Dorit Sohr¹, Brar C. Piening¹, Clemens de Grahl³, Elke Halle⁴, Henning Rüden¹ and Harald Seifert²

¹ Institute of Hygiene and Environmental Medicine, Charité University Medicine, Hindenburgdamm 27, 12203 Berlin, Germany

² Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany

³ Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany

⁴ Institute for Microbiology and Hygiene, Charité University Medicine, Berlin, Germany

Correspondence
Anke Kohlenberg
anke.kohlenberg{at}mikrobio.med.uni-giessen.de

Received May 19, 2009
Accepted July 9, 2009

A prolonged outbreak of carbapenem-resistant Acinetobacter baumannii in a German university medical centre in 2006 was investigated; the investigation included a descriptive epidemiological analysis, a case–control study, environmental sampling, molecular typing of A. baumannii isolates using PFGE and repetitive-sequence-based PCR (rep-PCR) typing, and detection of OXA-type carbapenemases by multiplex PCR. Thirty-two patients acquired the outbreak strain in five intensive care units (ICUs) and two regular wards at a tertiary care hospital within 10 months. The outbreak strain was resistant to penicillins, cephalosporins, ciprofloxacin, gentamicin, tobramycin, imipenem and meropenem, and carried the bla_OXA-23-like gene. Based on PFGE and rep-PCR typing, it was shown to be related to the pan-European A. baumannii clone II. The most likely mode of transmission was cross-transmission from colonized or infected patients via the hands of health-care workers, with the severity of disease and intensity of care (therapeutic intervention scoring system 28 score >median) being independently associated with acquisition of the outbreak strain (odds ratio 6.67, 95 % confidence interval 1.55–36.56). Control of the outbreak was achieved by enforcement of standard precautions, education of personnel, screening of ICU patients for carbapenem-resistant A. baumannii and cohorting of patients. This is believed to be the first report of an outbreak of A. baumannii carrying the carbapenemase OXA-23 in Germany.

Present address: Institute of Medical Microbiology, Justus Liebig University Giessen, Frankfurter Strasse 107, 35392 Giessen, Germany.