Infection Control Response to an Outbreak of OXA-23 Carbapenemase-Producing Carbapenem-Resistant Acinetobacter baumannii in a Skilled Nursing Facility in Utah.

Smith, Amanda R; Vowles, Maureen; Horth, Roberta Z; Smith, Lori; Rider, Linda; Wagner, Jennifer M; Sangster, Anna; Young, Erin L; Schuckel, Hailey; Stewart, James; Gruninger, Randon J; Rossi, Alessandro; Oakeson, Kelly F; Nakashima, Allyn K

BACKGROUND Antibiotic-resistant Acinetobacter spp. are a growing public health threat, yet are not nationally notifiable, and most states do not mandate reporting. Additionally, there are no standardized methods to detect Acinetobacter spp. colonization. METHODS An outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) was identified at a Utah skilled nursing facility with a ventilator unit (vSNF). An investigation was conducted to identify transmission modes in order to control spread of CRAB. Culture-based methods were used to identify patient colonization and environmental contamination in the facility. RESULTS Of the 47 patients screened, OXA-23-producing CRAB were detected in 10 patients (21%), with 7 patients (15%) having been transferred from out-of-state facilities. Of patients who screened positive, 60% did not exhibit any signs or symptoms of active infection by chart review. A total of 38 environmental samples were collected and CRAB was recovered from 37% of those samples. Whole genome sequencing analyses of patient and environmental isolates suggested repeated CRAB introduction into the facility and highlighted the role of shared equipment in transmission. CONCLUSION The investigation demonstrated this vSNF was an important reservoir for CRAB in the community and highlights the need for improved surveillance, strengthened infection control and inter-facility communication within and across states.