Clinical and molecular epidemiology of acinetobacter infections sensitive only to polymyxin B and sulbactam.

Abstract

A nosocomial outbreak of infections due to imipenem-resistant Acinetobacter baumannii occurred in a New York hospital after increased use of imipenem for cephalosporin-resistant klebsiella infections. We identified all A baumannii isolates over 12 months, reviewed corresponding patient records, and compared strains with different antibiotic susceptibility patterns by restriction endonuclease analysis. Environmental surveillance cultures were done before and after institution of control measures. 59 patients harboured imipenem-resistant A baumannii, and 18 were infected. Isolates from patients were resistant to all routinely tested antibiotics, including imipenem. Further studies showed susceptibility to polymyxin B and sulbactam. These isolates were identical by restriction endonuclease analysis to A baumannii isolates susceptible to imipenem alone, or to imipenem and amikacin, but differed from broadly susceptible isolates. Surveillance cultures showed hand and environmental colonisation by imipenem-resistant strains. Infection and colonisation were eliminated by intensive infection control measures, and irrigation of wounds with polymyxin B. Increased use of imipenem against cephalosporin-resistant klebsiella may lead to imipenem resistance among other species, particularly acinetobacter. Such resistance appears to derive from a prior multi-resistant clone, in contrast to one which retains susceptibility to several antibiotics.

• Authors: E S Go, C Urban, J Burns, B Kreiswirth, W Eisner, N Mariano, K Mosinka-Snipas, J J Rahal
• Journal: Lancet (London, England) (Lancet) Vol. 344 Issue 8933 Pg. 1329-32 (Nov 12 1994) ISSN: 0140-6736 [Print] England
• PMID: 7968028 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• DNA, Bacterial
• Imipenem
• Polymyxin B
• Sulbactam

Topics

• Acinetobacter (classification, drug effects, genetics)
• Acinetobacter Infections (drug therapy, epidemiology, microbiology)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cross Infection (drug therapy, epidemiology, microbiology)
• DNA, Bacterial (analysis)
• Disease Outbreaks
• Environmental Microbiology
• Humans
• Imipenem (therapeutic use)
• Microbial Sensitivity Tests
• Middle Aged
• New York (epidemiology)
• Polymyxin B (therapeutic use)
• Sulbactam (therapeutic use)