An integrated approach to control a prolonged outbreak of multidrug-resistant Pseudomonas aeruginosa in an intensive care unit M. Knoester, M.G.J. de.

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An integrated approach to control a prolonged outbreak of multidrug-resistant Pseudomonas aeruginosa in an intensive care unit M. Knoester, M.G.J. de Boer, J.J. Maarleveld, E.C.J. Claas, A.T. Bernards, E. de Jonge, J.T. van Dissel, K.E. Veldkamp Clinical Microbiology and Infection Volume 20, Issue 4, Pages O207-O215 (April 2014) DOI: 10.1111/1469-0691.12372 Copyright © 2014 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 1 Map of the Intensive Care Unit. Until December 2010, Intensive Care Units (ICUs) 1 and 2 were on a different floor level to ICUs 3 and 4. From December 2010 onwards, ICUs 3 and 4 were moved to be situated next to units 1 and 2. Clinical Microbiology and Infection 2014 20, O207-O215DOI: (10.1111/1469-0691.12372) Copyright © 2014 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 2 Epidemic curve of the outbreak with timing of infection control measures. Showing the number of new cases in time and timing of implementation of infection control measures. Dark bars reflect the patients with a Cluster 1 strain, light bars represent those with a Cluster 2 strain. One patient was colonized with strains from both clusters (striped bar). Clinical Microbiology and Infection 2014 20, O207-O215DOI: (10.1111/1469-0691.12372) Copyright © 2014 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 3 Example of AFLP results. Showing the homology within and between Clusters 1 and 2. Related and unrelated controls were tested in the same run to control for homology within related strains. Clinical Microbiology and Infection 2014 20, O207-O215DOI: (10.1111/1469-0691.12372) Copyright © 2014 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 4 Description of integrated approach used for this outbreak. After the first observation, infection control measures were re-enforced or newly implemented. Descriptive epidemiology identified rooms with a high number of cases and suggested interpatient transmission. This supported the importance of the fortified infection control measures. After three screening rounds that did not lead to a clear common source, a fourth screening round was directed by the findings of the case-control study and included culturing of faucets. Two faucets were found to be positive and were replaced, by which the common source was removed and the outbreak was brought to a halt. Clinical Microbiology and Infection 2014 20, O207-O215DOI: (10.1111/1469-0691.12372) Copyright © 2014 European Society of Clinical Infectious Diseases Terms and Conditions