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Title: Environmental colonization and onward clonal transmission of carbapenem-resistant Acinetobacter baumannii (CRAB) in a medical intensive care unit: The case for environmental hygiene
Authors: Ng, D.H.L
Marimuthu, K 
Lee, J.J
Khong, W.X
Ng, O.T 
Zhang, W
Poh, B.F
Rao, P
Raj, M.D.R
Ang, B
De, P.P
Keywords: carbapenem
Acinetobacter infection
antibiotic resistance
antibiotic sensitivity
bacterial colonization
bacterial transmission
bacterium colony
bacterium isolate
clinical article
controlled study
environmental sanitation
hospital acquired pneumonia
hospital admission
length of stay
medical intensive care unit
priority journal
throat culture
whole genome sequencing
Issue Date: 2018
Citation: Ng, D.H.L, Marimuthu, K, Lee, J.J, Khong, W.X, Ng, O.T, Zhang, W, Poh, B.F, Rao, P, Raj, M.D.R, Ang, B, De, P.P (2018). Environmental colonization and onward clonal transmission of carbapenem-resistant Acinetobacter baumannii (CRAB) in a medical intensive care unit: The case for environmental hygiene. Antimicrobial Resistance and Infection Control 7 (1) : 51. ScholarBank@NUS Repository.
Abstract: Background: In May 2015, we noticed an increase in carbapenem-resistant Acinetobacter baumannii (CRAB) infections in the Medical Intensive Care Unit (MICU). To investigate this, we studied the extent of environmental contamination and subsequent onward clonal transmission of CRAB. Methods: We conducted a one-day point prevalence screening (PPS) of the patients and environment in the MICU. We screened patients using endotracheal tube aspirates and swabs from nares, axillae, groin, rectum, wounds, and exit sites of drains. We collected environmental samples from patients' rooms and environment outside the patients' rooms. CRAB isolates from the PPS and clinical samples over the subsequent one month were studied for genetic relatedness by whole genome sequencing (WGS). Results: We collected 34 samples from seven patients and 244 samples from the environment. On the day of PPS, we identified 8 CRAB carriers: 3 who screened positive and 5 previously known clinical infections. We detected environmental contamination in nearly two-thirds of the rooms housing patients with CRAB. WGS demonstrated genetic clustering of isolates within rooms but not across rooms. We analysed 4 CRAB isolates from clinical samples following the PPS. One genetically-related CRAB was identified in the respiratory sample of a patient with nosocomial pneumonia, who was admitted to the MICU five days after the PPS. Conclusion: The extensive environmental colonization of CRAB by patients highlights the importance of environmental hygiene. The transmission dynamics of CRAB needs further investigation. © 2018 The Author(s).
Source Title: Antimicrobial Resistance and Infection Control
ISSN: 20472994
DOI: 10.1186/s13756-018-0343-z
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