Occupational Transmission of Acinetobacter baumannii from a United States Serviceman Wounded in Iraq to a Health Care Worker

• Published in: Clinical infectious diseases Vol. 47; no. 4; pp. 439 - 443
• Main Authors: Whitman, Timothy J., Qasba, Sonia S., Timpone, Joseph G., Babel, Britta S., Kasper, Matthew R., English, Judith F., Sanders, John W., Hujer, Kristine M., Hujer, Andrea M., Endimiani, Andrea, Eshoo, Mark W., Bonomo, Robert A.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.08.2008; University of Chicago Press; Oxford University Press
• Subjects: Acinetobacter; Acinetobacter baumannii; Acinetobacter baumannii - classification; Acinetobacter baumannii - drug effects; Acinetobacter baumannii - genetics; Acinetobacter baumannii - isolation & purification; Acinetobacter Infections - microbiology; Acinetobacter Infections - transmission; Anti-Bacterial Agents - pharmacology; Armed forces; Articles and Commentaries; Bacteria; Bacteriology; Biological and medical sciences; Civilian personnel; Disease transmission; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Health Personnel; Humans; Infections; Infectious Disease Transmission, Patient-to-Professional; Infectious diseases; Intensive care units; Iraq; Male; Medical personnel; Medical sciences; Middle Aged; Military Personnel; Occupational Exposure; Occupational health; Occupational transmission; Pathology; Pneumonia; Pneumonia, Bacterial - microbiology; Pneumonia, Bacterial - transmission; Polymerase Chain Reaction; Spectrometry, Mass, Electrospray Ionization; Sputum; United States; Warfare; Iraq; Asia; United States; North America; America; USA; Infection; Acinetobacter baumannii; Neisseriaceae; Transmission; Health care staff; Bacteria; Micrococcales; Wound
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/589247

Background. Acinetobacter baumannii is increasingly recognized as being a significant pathogen associated with nosocomial outbreaks in both civilian and military treatment facilities. Current analyses of these outbreaks frequently describe patient-to-patient transmission. To date, occupational transmission of A. baumannii from a patient to a health care worker (HCW) has not been reported. We initiated an investigation of an HCW with a complicated case of A. baumannii pneumonia to determine whether a link existed between her illness and A. baumannii-infected patients in a military treatment facility who had been entrusted to her care. Methods. Pulsed-field gel electrophoresis and polymerase chain reaction/electrospray ionization mass spectrometry, a form of multilocus sequencing typing, were done to determine clonality. To further characterize the isolates, we performed a genetic analysis of resistance determinants. Results and Conclusions. A “look-back” analysis revealed that the multidrug resistant A. baumannii recovered from the HCW and from a patient in her care were indistinguishable by pulsed-field gel electrophoresis. In addition, polymerase chain reaction/electrospray ionization mass spectrometry indicated that the isolates were similar to strains of A. baumannii derived from European clone type II (Walter Reed Army Medical Center strain type 11). The exposure of the HCW to the index patient lasted for only 30 min and involved endotracheal suctioning without use of an HCW mask. An examination of 90 A. baumannii isolates collected during this investigation showed that 2 major and multiple minor clone types were present and that the isolates from the HCW and from the index patient were the most prevalent clone type. Occupational transmission likely occurred in the hospital; HCWs caring for patients infected with A. baumannii should be aware of this potential mode of infection spread.