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. 2019 Mar 31;32(1):47-55.

Extensively drug-resistant Pseudomonas Aeruginosa outbreak in a burn unit: management and solutions

J Aguilera-Sáez  1 , V Andreu-Solà  1 , N Larrosa Escartín  1 , V Rodríguez Garrido  1 , L Armadans Gil  1 , J M Sánchez García  1 , M Campins  1 , J Baena Caparrós  1 , J P Barret  1
Affiliations

Extensively drug-resistant Pseudomonas Aeruginosa outbreak in a burn unit: management and solutions

J Aguilera-Sáez et al. Ann Burns Fire Disasters. .

Abstract
in English, French

Infections are still the main cause of mortality in burn patients. Multidrug resistant bacteria can cause outbreaks in critical care and burn units. We describe an outbreak of infection by extensively drug-resistant Pseudomonas aeruginosa in the Burn Unit of a University Hospital in Barcelona (Spain) between April and July 2016. A descriptive study of all cases, a bacterial colonization screening of all admitted patients and a microbiological environmental study were performed in order to detect a possible common focus. Contact isolation and cohortization of healthcare workers of all infected or colonized patients were applied. Environmental control measures were instituted for possible sources of infection. The outbreak was caused by a strain of P. aeruginosa only sensitive to colistin. Ten patients were infected or colonized and two of them died. The same strain was detected in several taps and drains in different rooms of the Unit. After applying control measures, changing faucets and drains, carrying out thermal disinfection of the hot water installation of the unit, disinfecting the rooms with ultraviolet radiation and placing antibacterial filtration devices in all the taps among other measures, an effective control of the outbreak was achieved.

Les infections sont toujours une cause majeure de mortalité chez les brûlés. Des épidémies à bactéries multirésistantes (BMR) dans les CTB sont régulièrement rapportées. Nous décrivons une épidémie due à Pseudomonas æruginosa BMR, sensible uniquement à la colimycine, survenue dans le CTB d’un hôpital universitaire de Barcelone entre avril et juillet 2016. Elle a touché 10 patients dont 2 sont morts. Une étude de chaque cas, un dépistage chez tous les entrants et une étude environnementale ont été réalisées, afin de trouver d’éventuelles similitudes. Un isolement contact et un cohorting ont été mis en place. Des mesures de contrôle de l’environnement ont été implémentées. La souche incriminée a été retrouvée dans plusieurs robinets et siphons du service. Cette épidémie a été résolue après, outre les mesures précitées, changement des robinets et des siphons (avec mise en place d’ultrafiltres sur les robinets), choc thermique du réseau d’adduction d’eau, désinfection terminale UV des chambres.

Keywords: Pseudomonas aeruginosa; burn centre; burns; extensively drug-resistant; outbreak.

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Figures

Table I
Table I. Summary of environmental studies, and objects from which the outbreak strain was isolated
Fig. 1
Fig. 1. Timeline of hospital stay of patients colonized or infected with the Pseudomonas aeruginosa outbreak strain, results from environmental samples, and outbreak control measures. The dashed lines represent patients over time and located in the different key rooms when the results of the cultures were negative for extensively drug-resistant P. aeruginosa (XDRPA). The continuous lines show when these results were positive. The red figures represent positive environmental samples (ES).
Fig. 2
Fig. 2. Schematic diagram of the burn unit. The rooms with positive environmental samples to XDR-PA are indicated by a circle and the patients infected or colonized by XDR-PA are represented with a star.
Table II
Table II. Characteristics of the cases of infection or colonization by extremely resistant Pseudomonas aeruginosa that occurred in the outbreak of the Burn Unit (TBSA: total body surface area)
See this image and copyright information in PMC

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