Take-Home Points
1) Due to regional increases in pan-non susceptible Acinetobacter baumannii cases, heightened awareness and focus on appropriate infection prevention and control measures are critical to prevent spread.
2) Continue to conduct prospective monitoring for pan-non susceptible Acinetobacter baumannii and Carbapenem-resistant Acinetobacter baumannii infection and colonization.
3) Request clinical laboratories to conduct laboratory lookback over the previous 3 months for pan-non susceptible Acinetobacter baumannii and Carbapenem-resistant Acinetobacter baumannii.
4) If pan-non susceptible Acinetobacter baumannii and/or Carbapenem-resistant Acinetobacter baumannii are identified in laboratory look-back or prospective surveillance, report cases to your local health department (and include the New Jersey Department of Health via email at DOH.CDS.HAIAR.EPI@doh.nj.gov). If encryption is available, please provide and laboratory report with the antimicrobial susceptibility profile and a digitally completed copy of the MDRO case report.
Summary
The New Jersey Department of Health (NJDOH) is notifying healthcare providers and public health partners to an increase of clinical and colonization cases, including outbreaks, of pan-non-susceptible Acinetobacter baumannii in New Jersey and across the country.
· Acinetobacter baummannii is opportunistic bacteria that has been linked to healthcare-associated, infections such as severe wound, respiratory, bloodstream, and urinary tract infections among patients with weakened immune systems or otherwise very sick patients; often, people can become colonized, demonstrating no symptoms of its presence.
· Acinetobacter baummannii is a challenging threat to hospitalized patients because it frequently contaminates surfaces, shared medical equipment, and healthcare personnel hands. If not addressed through infection prevention and control measures, including rigorous cleaning and disinfection and effective hand hygiene technique, healthcare settings can be sites of “silent outbreaks”—where individuals are colonized but do not necessarily show signs of infection.
· While Acinetobacter baummannii transmission has commonly occurred in long-term care and skilled nursing facilities that care for ventilated and severely ill patients, facilities of all types have been impacted in Acinetobacter baummannii outbreaks.
To compound the challenges and consequences of Acinetobacter baummannii, NJDOH has recently found higher numbers of infected patients with pan-non-susceptible Acinetobacter baummannii, meaning that the organism is not susceptible to any clinically available drug. Pan-non-susceptible Acinetobacter baummannii is an organism of highest concern that has been classified as an “urgent threat” by the Centers for Disease Control and Prevention (https://www.cdc.gov/drugresistance/biggest-threats.html). When infected with a pan-non-susceptible Acinetobacter baummannii—or even with Acinetobacter baummannii organisms that are resistant only to the Carbapenem class of antimicrobials (abbreviated “CRAB”)—patients are left with extremely limited antimicrobial treatment options.
NJDOH requests healthcare personnel and public health partners to maintain heightened awareness of pan-non susceptible Acinetobacter baummannii or Carbapenem-resistant Acinetobacter baummannii infections. If residents or patients in your facility have been identified to be infected or colonized through microbiological work-up and/or look-back, please notify your local health department and include the NJDOH Communicable Disease Service via email at DOH.CDS.HAIAR.EPI@doh.nj.gov. If you have encryption capabilities, please also include a laboratory report and antimicrobial susceptibility profile for the infection and a digitally completed copy of the MDRO case report form (see resources below for details).
Resources:
1. 2019 Antibiotic Resistance Threats Report, CDC: https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf
2. Gall E and Long A. (2020) Chapter 6: Carbapenem-Resistant Enterobacteriaceae. In Making Healthcare Safer III: A Critical Analysis of Existing and Emerging Patient Safety Practices. Agency for Healthcare Research and Quality; https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/making-healthcare-safer/mhs3/carbapenem-resistant-1.pdf
3. Multidrug Resistant Organism Case Report Form, NJDOH: https://www.nj.gov/health/cd/documents/topics/ar/MDROCaseReportForm.pdf
4. Perez S, Innes GK, Walters MS, et al. Increase in Hospital-Acquired Carbapenem-Resistant Acinetobacter baumannii Infection and Colonization in an Acute Care Hospital During a Surge in COVID-19 Admissions — New Jersey, February–July 2020. MMWR Morb Mortal Wkly Rep 2020;69:1827–1831. DOI: http://dx.doi.org/10.15585/mmwr.mm6948e1
Contact Information:
· Local health department contact information here: http://localhealth.nj.gov/
· NJDOH Communicable Disease Service; Infection Control, Healthcare, and Environmental Epidemiology Section: DOH.CDS.HAIAR.EPI@doh.nj.gov or (609) 826-5964 during business hours
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