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Colegio de Medicina Interna de México.

2013, Number 3

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Med Int Mex 2013; 29 (3)

Outbreak of Nosocomial Lower Respiratory Acinetobacter baumanni in Internal Medicine in a General Hospital in Mexico City

Ramírez-Sandoval MLP, Aranza-Aguilar JL, Varela-Ramirez MA, Garcia-Gonzalez A, Vélez-Castro G, Salcedo-Romero R, Fajardo-Luz MM, Cruz-Sánchez M, Moreno-Pérez FJ

Language: Spanish
References: 25
Page: 250-256
PDF size: 156.95 Kb.


ABSTRACT

Background: Acinetobacter baumannii is a Gram-negative coccobacillus that has become an important nosocomial pathogen due to its ability to develop multidrug resistance or antimicrobial panresistance and to colonize and infect patients and persist in the hospital environment. It can survive on inanimate surfaces such as mechanical ventilators, sinks, catheters, mattresses, and walls due to its versatility to use different carbon sources and to grow in different conditions of moisture, pH and temperature.
Objectives: To describe the outbreak of nosocomial lower respiratory tract infection by Acinetobacter baumannii in the Internal Medicine Department of the General Hospital of Zone 32 Mario Madrazo Navarro which began on December 2, 2010 and was controlled on January 30, 2011.
Material and Methods: This was a retrospective, descriptive, and observational study that included all patients admitted to the Internal Medicine Department between December 1, 2010 and January 30, 2011 who reported A. baumannii isolation. The definitions for “nosocomial infection” were taken from the Nosocomial and Ventilator Associated Pneumonia Interamerican Consensus Conference Report, the Centers for Disease Control and Prevention, and the NOM-045-SSA2 2005. All strains were isolated from suction samples, bronchial secretion or purulent drainage from the endotracheal tube. They were identified following the methodology of the automated system VITEK 2 Compact, and showed correct identification with over 95% probability.
Results: During the period studied 33 patients were hospitalized, 15 of them met the operational definition of the case and were taken for analysis. In gender distribution: 10 (66.6%) were female. The age limits were 28 and 90 years, with a mean of 52 years. The mean of duration of lower respiratory tract infection from the date of entry was five days, with a range of 3 to 20 days. The signs and symptoms of infection included: fever in 12 patients (80%) and 10 cases of fetid bronchial secretions (66%). The first case was recorded on December 2 and the second case on 11 December 2010. In all patients A. baumannii was isolated, which behaved MDR. Treatment was indicated according to the reported sensitivity. In those who were sensitive to beta-lactamase inhibitor, like ampicillin/sulbactam, the bacteria was sensitive to a minimum inhibitory concentration (MIC) of ‹2 mcg / mL.
Conclusions: It is important to consider that doctors should practice preventive medicine and become aware of the need to implement these four key strategies to prevent nosocomial infections by multiresistant or panresistant germs: hand washing, thorough cleaning of inert material, temporal isolation of infected patients, and the rational prescription of antibiotics.


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