An outbreak of multidrug-resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment

Lisa L. Maragakis, Sara E. Cosgrove, Xiaoyan Song, Denny Kim, Patricia Rosenbaum, Nancy Ciesla, Arjun Srinivasan, Tracy Ross, Karen Carroll, Trish M. Perl

Research output: Contribution to journalReview article

94 Citations (Scopus)

Abstract

Context: Pulsatile lavage is a high-pressure irrigation treatment used increasingly in a variety of health care settings to debride wounds. Infection control precautions are not routinely used during the procedure and are not included in pulsatile lavage equipment package labeling. Objectives: To investigate an outbreak of multidrug- resistant Acinetobacter baumannii and to test the hypothesis that pulsatile lavage wound treatment was the mode of transmission for the organism. Design: Outbreak case-control investigation including case identification, review of medical records, environmental cultures, and pulsed-field gel electrophoresis. Setting: A 1000-bed tertiary care hospital in Baltimore, Md, during September and October 2003. Patients: The investigation included 11 patients infected or colonized with multidrug-resistant A baumannii. Seven of these patients met the case definition for the case-control study and were compared with 28 controls randomly selected from a list of inpatients without multidrug-resistant A baumannii who had a wound care consultation. Main Outcome Measure: Infection or colonization with multidrug-resistant A baumannii. Results: Eleven patients had cultures that grew multidrug-resistant A baumannii during the outbreak period. Of the 10 health care-associated cases, 8 had received pulsatile lavage treatment. One strain of multidrug-resistant A baumannii was recovered from all 6 pulsatile lavage patients who had isolates available for pulsed-field gel electrophoresis analysis and from multiple surfaces in the wound care area. Six of 7 cases (86%) were treated with pulsatile lavage vs 4 of 28 controls (14%) (odds ratio, 36; 95% confidence interval, 2.8-1721; P<.001). These results confirm that pulsatile lavage was a significant risk factor for acquisition of multidrug-resistant A baumannii. Conclusions: Transmission was apparently caused by dissemination of multidrug-resistant A baumannii during the pulsatile lavage procedure, resulting in environmental contamination. Appropriate infection control precautions should be used during pulsatile lavage therapy and should be included in pulsatile lavage equipment labeling.

Original languageEnglish (US)
Pages (from-to)3006-3011
Number of pages6
JournalJournal of the American Medical Association
Volume292
Issue number24
DOIs
StatePublished - Dec 22 2004

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Acinetobacter baumannii
Therapeutic Irrigation
Disease Outbreaks
Wounds and Injuries
Therapeutics
Pulsed Field Gel Electrophoresis
Infection Control
Delivery of Health Care
Equipment and Supplies
Baltimore
Tertiary Healthcare
Tertiary Care Centers
Medical Records
Case-Control Studies
Inpatients
Referral and Consultation
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals
Pressure

ASJC Scopus subject areas

  • Medicine(all)

Cite this

An outbreak of multidrug-resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment. / Maragakis, Lisa L.; Cosgrove, Sara E.; Song, Xiaoyan; Kim, Denny; Rosenbaum, Patricia; Ciesla, Nancy; Srinivasan, Arjun; Ross, Tracy; Carroll, Karen; Perl, Trish M.

In: Journal of the American Medical Association, Vol. 292, No. 24, 22.12.2004, p. 3006-3011.

Research output: Contribution to journalReview article

Maragakis, LL, Cosgrove, SE, Song, X, Kim, D, Rosenbaum, P, Ciesla, N, Srinivasan, A, Ross, T, Carroll, K & Perl, TM 2004, 'An outbreak of multidrug-resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment', Journal of the American Medical Association, vol. 292, no. 24, pp. 3006-3011. https://doi.org/10.1001/jama.292.24.3006
Maragakis, Lisa L. ; Cosgrove, Sara E. ; Song, Xiaoyan ; Kim, Denny ; Rosenbaum, Patricia ; Ciesla, Nancy ; Srinivasan, Arjun ; Ross, Tracy ; Carroll, Karen ; Perl, Trish M. / An outbreak of multidrug-resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment. In: Journal of the American Medical Association. 2004 ; Vol. 292, No. 24. pp. 3006-3011.
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abstract = "Context: Pulsatile lavage is a high-pressure irrigation treatment used increasingly in a variety of health care settings to debride wounds. Infection control precautions are not routinely used during the procedure and are not included in pulsatile lavage equipment package labeling. Objectives: To investigate an outbreak of multidrug- resistant Acinetobacter baumannii and to test the hypothesis that pulsatile lavage wound treatment was the mode of transmission for the organism. Design: Outbreak case-control investigation including case identification, review of medical records, environmental cultures, and pulsed-field gel electrophoresis. Setting: A 1000-bed tertiary care hospital in Baltimore, Md, during September and October 2003. Patients: The investigation included 11 patients infected or colonized with multidrug-resistant A baumannii. Seven of these patients met the case definition for the case-control study and were compared with 28 controls randomly selected from a list of inpatients without multidrug-resistant A baumannii who had a wound care consultation. Main Outcome Measure: Infection or colonization with multidrug-resistant A baumannii. Results: Eleven patients had cultures that grew multidrug-resistant A baumannii during the outbreak period. Of the 10 health care-associated cases, 8 had received pulsatile lavage treatment. One strain of multidrug-resistant A baumannii was recovered from all 6 pulsatile lavage patients who had isolates available for pulsed-field gel electrophoresis analysis and from multiple surfaces in the wound care area. Six of 7 cases (86{\%}) were treated with pulsatile lavage vs 4 of 28 controls (14{\%}) (odds ratio, 36; 95{\%} confidence interval, 2.8-1721; P<.001). These results confirm that pulsatile lavage was a significant risk factor for acquisition of multidrug-resistant A baumannii. Conclusions: Transmission was apparently caused by dissemination of multidrug-resistant A baumannii during the pulsatile lavage procedure, resulting in environmental contamination. Appropriate infection control precautions should be used during pulsatile lavage therapy and should be included in pulsatile lavage equipment labeling.",
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AU - Maragakis, Lisa L.

AU - Cosgrove, Sara E.

AU - Song, Xiaoyan

AU - Kim, Denny

AU - Rosenbaum, Patricia

AU - Ciesla, Nancy

AU - Srinivasan, Arjun

AU - Ross, Tracy

AU - Carroll, Karen

AU - Perl, Trish M.

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Y1 - 2004/12/22

N2 - Context: Pulsatile lavage is a high-pressure irrigation treatment used increasingly in a variety of health care settings to debride wounds. Infection control precautions are not routinely used during the procedure and are not included in pulsatile lavage equipment package labeling. Objectives: To investigate an outbreak of multidrug- resistant Acinetobacter baumannii and to test the hypothesis that pulsatile lavage wound treatment was the mode of transmission for the organism. Design: Outbreak case-control investigation including case identification, review of medical records, environmental cultures, and pulsed-field gel electrophoresis. Setting: A 1000-bed tertiary care hospital in Baltimore, Md, during September and October 2003. Patients: The investigation included 11 patients infected or colonized with multidrug-resistant A baumannii. Seven of these patients met the case definition for the case-control study and were compared with 28 controls randomly selected from a list of inpatients without multidrug-resistant A baumannii who had a wound care consultation. Main Outcome Measure: Infection or colonization with multidrug-resistant A baumannii. Results: Eleven patients had cultures that grew multidrug-resistant A baumannii during the outbreak period. Of the 10 health care-associated cases, 8 had received pulsatile lavage treatment. One strain of multidrug-resistant A baumannii was recovered from all 6 pulsatile lavage patients who had isolates available for pulsed-field gel electrophoresis analysis and from multiple surfaces in the wound care area. Six of 7 cases (86%) were treated with pulsatile lavage vs 4 of 28 controls (14%) (odds ratio, 36; 95% confidence interval, 2.8-1721; P<.001). These results confirm that pulsatile lavage was a significant risk factor for acquisition of multidrug-resistant A baumannii. Conclusions: Transmission was apparently caused by dissemination of multidrug-resistant A baumannii during the pulsatile lavage procedure, resulting in environmental contamination. Appropriate infection control precautions should be used during pulsatile lavage therapy and should be included in pulsatile lavage equipment labeling.

AB - Context: Pulsatile lavage is a high-pressure irrigation treatment used increasingly in a variety of health care settings to debride wounds. Infection control precautions are not routinely used during the procedure and are not included in pulsatile lavage equipment package labeling. Objectives: To investigate an outbreak of multidrug- resistant Acinetobacter baumannii and to test the hypothesis that pulsatile lavage wound treatment was the mode of transmission for the organism. Design: Outbreak case-control investigation including case identification, review of medical records, environmental cultures, and pulsed-field gel electrophoresis. Setting: A 1000-bed tertiary care hospital in Baltimore, Md, during September and October 2003. Patients: The investigation included 11 patients infected or colonized with multidrug-resistant A baumannii. Seven of these patients met the case definition for the case-control study and were compared with 28 controls randomly selected from a list of inpatients without multidrug-resistant A baumannii who had a wound care consultation. Main Outcome Measure: Infection or colonization with multidrug-resistant A baumannii. Results: Eleven patients had cultures that grew multidrug-resistant A baumannii during the outbreak period. Of the 10 health care-associated cases, 8 had received pulsatile lavage treatment. One strain of multidrug-resistant A baumannii was recovered from all 6 pulsatile lavage patients who had isolates available for pulsed-field gel electrophoresis analysis and from multiple surfaces in the wound care area. Six of 7 cases (86%) were treated with pulsatile lavage vs 4 of 28 controls (14%) (odds ratio, 36; 95% confidence interval, 2.8-1721; P<.001). These results confirm that pulsatile lavage was a significant risk factor for acquisition of multidrug-resistant A baumannii. Conclusions: Transmission was apparently caused by dissemination of multidrug-resistant A baumannii during the pulsatile lavage procedure, resulting in environmental contamination. Appropriate infection control precautions should be used during pulsatile lavage therapy and should be included in pulsatile lavage equipment labeling.

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