Identification and management of infectious outbreaks in the critical care unit

Current Opinion in Critical Care

Volumn 2, Issue 5, 1996, Pages 352-360

  Harbarth, Stephan ^a   Pittet, Didier ^a  

^a GENEVA UNIVERSITY HOSPITALS   (Switzerland)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 0003056142     PISSN: 10705295     EISSN: None     Source Type: Journal    
DOI: 10.1097/00075198-199610000-00003     Document Type: Article

References (99)

1. Bloom BR, Murray CJL: Tuberculosis: commentary on a reemergent killer. Science 1992, 257:1055-1064.
2. Pinner RW, Teutsch SM, Simonsen L, et al.: Trends in infectious diseases mortality in the United States. JAMA 1996, 275:189-193. Interesting evaluation of recent trends in infectious diseases mortality in the United States.
3. Wenzel RP, Thompson RL, Landry SM, et al.: Hospital-acquired infections in intensive care unit patients: an overview with emphasis on epidemics. Infect Control 1983, 4:371-375.
4. Craven DE, Kunches LM, Lichtenberg DA: Nosocomial infection and fatality in medical surgical intensive care unit patients. Arch Intern Med 1988, 148:1161-1168.
5. Martin MA: Nosocomial infections in intensive care units: an overview of their epidemiology, outcome, and prevention. New Horizons 1993, 1:162-171.
6. Pittet D, Harbarth SJ: The intensive care unit. In Hospital Infections, edn 4. Edited by Bennett JV, Brachman PS. Boston: Little, Brown, and Company; 1996, in press. Complete update of information about ICU-infections.
7. Weinstein RA: Epidemiology and control of nosocomial infections in adult intensive care units. Am J Med 1991, 91:179S-184S.
8. Rees JC, Allen KD: Holy water: a risk factor for hospital-aquired infection. J Hosp Infect 1996, 32:51-55.
9. Huebner J, Pier GB, Maslow JN, et al.: Endemic nosocomial transmission of Staphylococcus epidermidis bacteremia isolates in a neonatal intensive care unit. J Infect Dis 1994, 169:526-531.
10. Lyytikainen O, Saxen H, Ryhanen R, Vaara M, Vuopio Varkila J: Persistence of a multiresistant clone of Staphylococcus epidermidis in a neonatal intensive-care unit for a four-year period. Clin Infect Dis 1995, 20:24-29. In this interesting report about a cluster of cases of Staphylococcus epidermidis bacteremia in a neonatal ICU, the authors conclude that S. epidermidis cross-infections are very common in the neonatal ICU setting.
11. Jacquez GM, Waller LA, Grimson R, Wartenberg D: The analysis of disease clusters: part I. State of the art. Infect Control Hosp Epidemiol 1996, 17:319-327.
12. Pittet D: Nosocomial bloodstream infections. In Prevention and Control of Nosocomial Infections, edn 3. Edited by Wenzel RP. Boston: Williams and Wilkins; 1996, in press.
13. Zaza S, Jarvis WR: Investigations of outbreaks. In Hospital Epidemiology and Infection Control, edn 1. Edited by Mayhall G. Williams and Wilkins; 1996:105-113. Good overview article for anybody interested in knowing more about outbreak investigation.
14. Brun-Buisson C, Legrand P, Philippon A, Montravers F, Ansquer M, Duval J: Transferable enzymatic resistance to third-generation cephalosporins during nosocomial outbreak of multiresistant Klebsiella pneumoniae. Lancet 1987, ii:302-306.
15. Price DJ, Sleigh J: Control of infection due to Klebsiella aerogenes in a neurosurgical unit by withdrawal of all antibiotics. Lancet 1970, ii:1213-1215.
16. Sirot J, Chanal C, Petit A, Sirot D, Labia R, Gerbaud G: Klebsiella pneumoniae and other Enterobacteriaceae producing novel plasmid-mediated beta-lactamases markedly active against third-generation cephalosporins: epidemiologic studies. Rev Infect Dis 1988, 10:850-859.
17. Meyer KS, Urban C, Eagan JA, Berger BJ, Rahal JJ: Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993, 119:353-358.
18. Scerpella EG, Wanger AR, Armitige L, Anderlini P, Ericsson CD: Nosocomial outbreak caused by a multiresistant clone of Acinetobacter baumannii: results of the case-control and molecular epidemiologic investigations. Infect Control Hosp Epidemiol 1995, 16:92-97.
19. Prodinger WM, Fille M, Bauernfeind A, et al.: Molecular epidemiology of Klebsiella pneumoniae producing SHV-5 β-lactamase: parallel outbreaks due to multiple plasmid transfer. J Clin Microbiol 1996, 34:564-568.
20. Chow JW, Kuritza A, Schlaes DM, Green M, Sahm DF, Zervos MJ: Clonal spread of vancomycin-resistant Entreococcus faecium between patients in three hospitals in two states. J Clin Microbiol 1993, 31:1609-1611.
21. Morris JG, Shay DK, Hebden JN, et al.: Enterococci resistant to multiple antimicrobial agents including vancomycin: establishment of endemicity in a university medical center. Ann Intern Med 1995, 123:250-259. Vancomycin-resistant enterococci become an increasing problem worldwide. This article describes the natural history of vancomycin-resistant enterococci in a university hospital.
22. Boyce JM: Vancomycin-resistant enterococci: pervasive and persistent pathogens. Infect Control Hosp Epidemiol 1995, 16:676-679.
23. Harbarth S, Pittet D: Excess mortality and impact of intensive care unit-acquired infections. Curr Opin Anaesthesiol 1996, 9:139-145.
24. Camargo LF, Strabelli TM, Ribeiro FG, et al.: Epidemiologic investigation of an outbreak of coagulase-negative Staphylococcus primary bacteremia in a newborn intensive care unit. Infect Control Hosp Epidemiol 1995, 16:595-596.
25. Chowdhury MN, Kambal A: An outbreak of infection due to Staphylococcus aureus phage type 522 in a neonatal intensive care unit. J Hosp Infect 1992, 22:299-305.
26. Tankovic J, Legrand P, De Gatines G, Chemineau V, Brun Buisson C, Duval J: Characterization of a hospital outbreak of imipenem-resistant Acinetobacter baumannii by phenotypic and genotypic typing methods. J Clin Microbiol 1994, 32:2677-2681.
27. Livornese LL, Jr., Dias S, Samel C, et al.: Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992, 117:112-116.
28. Bennett SN, McNeil MM, Bland LA, et al.: Postoperative infections traced to contamination of an intravenous anesthetic, propofol. N Engl J Med 1995, 333:147-154. Elegant epidemiologic study on an outbreak of postoperative infections due to extrinsic contamination of a parenteral medication.
29. Trilla A, Codina C, Salles M, et al.: A cluster of fever and hypotension on a surgical intensive care unit related to the contamination of plasma expanders by cell wall products of Bacillus stearothermophilus. Infect Control Hosp Epidemiol 1995, 16:335-339.
30. Pertowski CA, Baron RC, Lasker BA, Werner SB, Jarvis WR: Nosocomial outbreak of Candida albicans sternal wound infections following cardiac surgery traced to a scrub nurse. J Infect Dis 1995, 172:817-822. This study demonstrates the utility of combining epidemiologic methods and molecular typing in investigating C. albicans infection clusters and suggests that a common exogenous source can be responsible for C. albicans surgical wound infections.
31. File TM, Jr., Tan JS, Thomson RB, Jr., Stephens C, Thompson P: An outbreak of Pseudomonas aeruginosa ventilator-associated respiratory infections due to contaminated food coloring dye: further evidence of the significance of gastric colonization preceding nosocomial pneumonia. Infect Control Hosp Epidemiol 1995, 16:417-418.
32. Mahajan R, Mathur M, Kumar A, Gupta P, Faridi MM, Talwar V: Nosocomial outbreak of Salmonella typhimurium infection in a nursery intensive care unit (NICU) and paediatric ward. J Commun Dis 1995, 27:10-14.
33. McGowan JE, Jr., Metchock BG: Basic microbiologie support for hospital epidemiology. Infect Control Hosp Epidemiol 1996, 17:298-303.
34. Jarvis WR: Usefulness of molecular epidemiology for outbreak investigations. Infect Control Hosp Epidemiol 1994, 15:500-503.
35. Grattard F, Pozzetto B, Berthelot P, et al.: Arbitrarily primed PCR, ribotyping, and plasmid pattern analysis applied to investigation of a nosocomial outbreak due to Enterobacter cloacae in a neonatal intensive care unit. J Clin Microbiol 1994, 32:596-602.
36. Georghiou PR, Hamill RJ, Wright CE, et al.: Molecular epidemiology of infections due to Enterobacter aerogenes: identification of hospital outbreak-associated strains by molecular techniques. Clin Infect Dis 1995, 20:84-94.
37. Debast SB, Melchers WJ, Voss A, Hoogkamp Korstanje JA, Meis JF: Epidemiological survey of an outbreak of multiresistant Serratia marcescens by PCR-fingerprinting. Infection 1995, 23:267-271.
38. Traub WH, Leonhard B, Bauer D: Gentamicin- and methicillin-resistant Staphylococcus aureus: phenotypic and genotypic characterization of three putative nosocomial outbreak strains. Chemotherapy 1996, 42:21-36.
39. Vannuffel P, Gigi J, Ezzedine H, et al.: Specific detection of methicillin-resistant Staphylococcus species by multiplex PCR. J Clin Microbiol 1995, 33:2864-2867.
40. Grundmann H, Schneider C, Hartung D, Daschner FD, Pitt TL: Discriminatory power of three DNA-based typing techniques for Pseudomonas aeruginosa. J Clin Microbiol 1995, 33:528-534.
41. Kerr JR, Moore JE, Curran MD, et al.: Investigation of a nosocomial outbreak of Pseudomonas aeruginosa pneumonia in an intensive care unit by random amplification of polymorphic DNA assay. J Hosp Infect 1995, 30:125-131.
42. Crowe M, Towner KJ, Humphreys H: Clinical and epidemiological features of an outbreak of acinetobacter infection in an intensive therapy unit. J Med Microbiol 1995, 43:55-62.
43. Voss A, Pfaller MA, Mollis RJ, Rhine Chalberg J, Doebbeling BN: Investigation of Candida albicans transmission in a surgical intensive care unit cluster by using genomic DNA typing methods. J Clin Microbiol 1995, 33:576-580.
44. Jumaa P, Chattopadhyay B: Outbreak of gentamicin, ciprofloxacin-resistant Pseudomonas aeruginosa in an intensive care unit, traced to contaminated quivers. J Hosp Infect 1994, 28:209-218.
45. Mulin B, Talon D, Viel JF, et al.: Risk factors for nosocomial colonization with multiresistant Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis 1995, 14:569-576.
46. Lortholary O, Fagon JY, Hoi AB, et al.: Nosocomial acquisition of multiresistant Acinetobactar baumannii: risk factors and prognosis. Clin Infect Dis 1995, 20:790-796.
47. Lucet JF, Chevret S, Deere D, et al.: Outbreak of multiply resistant enterobacteriaceae in an intensive care unit: epidemiology and risk factors for acquisition. Clin Infect Dis 1996, 22:430-436.
48. Simmons B, Bryant J, Neiman K, Spencer L, Arheart K: The role of handwashing in prevention of endemic intensive care unit infections. Infect Control Hosp Epidemiol 1990, 11:589-594.
49. Humphreys H, Towner KJ, Crowe M, Webster C, Winter R: Acinetobacter infections, intensive care units, and handwashing [letter; comment]. Lancet 1995, 345:121.
50. Wenzel RP, Pfaller MA: Handwashing: efficacy versus acceptance. A brief essay. J Hosp Infect 1991, 18(suppl B):65-68.
51. Haley RW, Bregman D: The role of understating and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. J Infect Dis 1982, 145:875-885.
52. Fridkin SK, Pear SM, Williamson T, Galgiani JN, Jarvis WR: The role of understating in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996, 17:150-158. Excellent analysis by Fridkin et al. regarding the importance of understaffing as a risk factor for nosocomial infection.
53. Soulier A, Barbut F, Ollivier JM, Petit JC, Lienhart A: Decreased transmission of Enterobacteriaceae with extended-spectrum beta-lactamases in an intensive care unit by nursing reorganization. J Hosp Infect 1995, 31:89-97. An interesting study about the relationship between transmission of multidrug-resistant organisms and workload in a critical care unit.
54. Farr BM: Understanding: a risk factor for infection in the era of down sizing? Infect Control Hosp Epidemiol 1996, 17:147-149.
55. Lyytikainen O, Koljalg S, Harma M, Vuopio Varkila J: Outbreak caused by two multi-resistant Acinetobacter baumannii clones in a burns unit: emergence of resistance to imipenem. J Hosp Infect 1995, 31:41-54.
56. Bergogne Berezin E: The increasing significance of outbreaks of Acinetobacter spp: the need for control and new agents. J Hosp Infect 1995, 30 Suppl:441-452.
57. Aubert G, Grimont F, Zeni F, et al.: Acinetobacter baumanni outbreak isolates characterized by three typing methods. Eur J Clin Microbiol Infect Dis 1995, 14:1095-1099.
58. Reagan DR, Pfaller MA, Mollis RJ, Wenzel RP: Evidence of nosocomial spread of Candida albicans causing bloodstream infection in a neonatal intensive care unit. Diagn Microbiol Infect Dis 1995, 21:191-194.
59. Becks VE, Lorenzoni NM: Pseudomonas aeruginosa outbreak in a neonatal intensive care unit: a possible link to contaminated hand lotion. Am J Infect Control 1995, 23:396-398.
60. Goetz AM, Rihs JD, Chow JW, Singh N, Muder RR: An outbreak of infusion-related Klebsiella pneumoniae bacteremia in a liver transplantation unit. Clin Infect Dis 1995, 21:1501-1503.
61. French GL, Shannon KP, Simmons N: Hospital outbreak of Klebsiella pneumoniae resistant to broad-spectrum cephalosporins and β-lactam-β-lactamase inhibitor combinations by hyperproduction of SHV-5 β-lactamase. J Clin Microbiol 1996, 34:358-363.
62. Guiguet M, Rekacewicz C, Leclercq B, Brun Y, Escudier B, Andremont A: Effectiveness of simple measures to control an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections in an intensive care unit. Infect Control Hosp Epidemiol 1990, 11:23-26.
63. Cox RA, Conquest C, Mallaghan C, Marples RR: A major outbreak of methicillin-resistant Staphylococcus aureus caused by a new phage-type (EMRSA-16). J Hosp Infect 1995, 29:87-106.
64. Lingnau W, Allerberger F: Control of an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) by hygienic measures in a general intensive care unit. Infection 1994, 22 Suppl 2:5135-9.
65. Jernigan JA, Titus MG, Gröschel DHM, Getchell-White SI, Farr BM: Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996, 143:496-504.
66. Haley R, Cushion N, Tenover F, et al.: Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995, 171:614-624. Fundamental article for anybody interested in the field of MRSA surveillance and control.
67. Sherertz RJ, Reagan DR, Hampton KD, et al.: A cloud adult: The Staphylococcus aureus-virus interaction revisited. Ann Intern Med 1996, 124:539-547. Landmark article about possible spread of MRSA via airborne transmission.
68. Reagan DR, Doebbeling BN, Pfaller MA, et al.: Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. Ann Intern Med 1991, 114:101-106.
69. Hill RLR, Duckworth GL, Casewell MW: Elimination of nasal carriage of methicillin-resistant Staphylococcus aureus with mupirocin during a hospital outbreak. J Antimicrob Chemother 1988, 22:377-384.
70. Talon D, Rouget C, Cailleaux V, et al.: Nasal carriage of Staphylococcus aureus and cross-contamination in a surgical intensive care unit: efficacy of mupirocin ointment. J Hosp Infect 1995, 30:39-49.
71. Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP: Risk factors for hospital-acquired candidemia: a matched case-control study. Arch Intern Med 1989, 149:2349-2353.
72. Solomkin JS, Flohr AB, Quie PG, Simmons RL: The role of Candida in intraperitoneal infections. Surgery 1980, 88:524-530.
73. Pittet D, Monod M, Suter PM, Frenk E, Auckenthaler R: Candida colonization and subsequent infections in critically III surgical patients. Ann Surg 1994, 220:751-758.
74. Pittet D, Garbino J: Fungal infections in the critically ill. Curr Opin Crit Care 1995, 1:369-380.
75. Burnie JP, Odds FC, Lee W, Webster C, Williams JD: Outbreak of systemic Candida albicans in intensive care unit caused by cross infection. BMJ 1985, 290:746-748.
76. Vaudry WL, Tierney AJ, Wenman WM: Investigation of a cluster of systemic Candida albicans infections in a neonatal intensive care unit. J Infect Dis 1988, 158:1375-1379.
77. Matthews R, Burnie J: Assessment of DNA fingerprints for rapid identifications of outbreaks of systemic candidiasis. BMJ 1989, 298:357-364.
78. Burnie JP, Odds FC, Lee W, Webster C, Williams J: Outbreak of systemic Candida albicans in intensive care unit caused by cross infection. Br Med J 1985, 290:746-748.
79. Sherertz RJ, Gledhill KS, Hampton KD, et al.: Outbreak of Candida bloodstream infections associated with retrograde medication administration in a neonatal intensive care unit. J Pediatr 1992, 120:455-461.
80. Phelps M, Ayliffe GAJ, Babb JR: An outbreak of candidiasis in a special care baby unit: the use of a resistogram typing method. J Hosp Infect 1986, 7:13-20.
81. Stevens DA, Odds FC, Scherer S: Applications of DNA typing methods to Candida albicans epidemiology and correlations with phenotype. Rev Infect Dis 1990, 12:258-266.
82. Rudnick JR, Beck-Sague CM, Anderson RL, Schable B, Miller JM, Jarvis WR: Gram-negative bacteremia in open-heart-surgery patients traced to probable tap-water contamination of pressure-monitoring equipment. Infect Control Hosp Epidemiol 1996, 17:281-285.
83. Mermel LA, Maki DG: Epidemic bloodstream infections from hemodynamic pressure monitoring: signs of the times. Infect Control Hosp Epedemiol 1989, 10:47-53.
84. Beck-Sague CM, Jarvis WR: Epidemic bloodstream infections associated with pressure transducers: a persistent problem. Infect Control Hosp Epidemiol 1989, 10:54-59.
85. Villarino ME, Jarvis WR, O'Hara C, Bresnahan J, Clark N: Epidemic of Serratia marcescens bacteremia in a cardiac intensive care unit. J Clin Microbiol 1989, 27:2433-2436.
86. Hekker TA, van Overhagen W, Schneider AJ: Pressure transducers: an overlooked source of sepsis in the intensive care unit. Intensive Care Med 1990, 16:511-512.
87. Beck-Saguë CM, Jarvis WR, Brook JH, et al.: Epidemic bacteremia due to Acinetobacter baumannii in five intensive care units. Am J Epidemiol 1990, 132:723-733.
88. Widmer AF, Wenzel RP, Trilla A, Bale MJ, Jones RN, Doebbeling B: Outbreak of Pseudomonas aeruginosa infections in a surgical intensive care unit: probable transmission via hands of a health care worker. Clin Infect Dis 1993, 16:372-376.
89. Dubbert PM, Dolce J, Richter W, Miller M, Chapman S: Increasing ICU staff handwashing: effects of education and group feedback. Infect Control Hosp Epidemiol 1990, 11:191-193.
90. Weems JJ: Nosocomial outbreak of Pseudomonas cepacia associated with contamination of reusable electronic ventilator temperature probes. Infect Control Hosp Epidemiol 1993, 14:583-586.
91. Wright IM, Orr H, Porter C: Stethoscope contamination in the neonatal intensive care unit. J Hosp Infect 1995, 29:65-68.
92. Cefai C, Richards J, Gould FK, McPeake P: An outbreak of Acinetobacter respiratory tract infection resulting from incomplete disinfection of ventilatory equipment. J Hosp Infect 1990, 15:177-182.
93. Kolmos HJ, Thuesen B, Nielsen SV, Lohmann M, Kristoffersen K, Rosdahl VT: Outbreak of infection in a burns unit due to Pseudomonas aeruginosa originating from contaminated tubing used for irrigation of patients. J Hosp Infect 1993, 24:11-21.
94. Richard P, Le Roch R, Chamoux C, Pannier M, Espaze E, Richet H: Pseudomonas aeruginosa outbreak in a burn unit: role of antimicrobials in the emergence of multiply resistant strains. J Infect Dis 1994, 170:377-383.
95. Bryce EA, Smith JA: Focused microbiological surveillance and gram-negative beta-lactamase: mediated resistance in an intensive care unit. Infect Control Hosp Epidemiol 1995, 16:331-334.
96. Brun-Buisson C, Legrand P, Rauss A: Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli: study of an outbreak in an intensive care unit. Ann Intern Med 1989, 110:873-881.
97. Flynn DM, Weinstein RA, Nathan C, Gaston MA, Kabins S: Patients' endogenous flora as the source of "nosocomial" Enterobacter in cardiac surgery. J Infect Dis 1987, 156:363-368.
98. Hamill RJ, Houston ED, Georghiou PR, et al.: An outbreak of Burkholderia (formerly Pseudomonas) cepacia respiratory tract colonization and infection associated with nebulized albuterol therapy. Ann Intern Med 1995, 122:762-766. Thorough investigation of an infectious outbreak of Burkholderia (formerly Pseudomonas) cepacia respiratory tract colonization and infections.
99. Nichols RL, Smith JW: Bacterial contamination of an anesthetic agent. N Engl J Med 1995, 333:184-185.