In 2014/2015, nine patients with multidrug-resistant A. baumannii were documented at the Burn Center at Uppsala University Hospital, Uppsala, Sweden. All patients were related to an OXA-23 producing A. baumannii that belonged to sequence type 15. Reduced use of broad-spectrum antibiotics combined with strict compliance to hand hygiene and dress codes and well-performed cleaning contributed to control the outbreak and impeded new outbreaks for the following five years.. Multimodal Interventions to Control the Spread of Multidrug-resistant Sequence Type 15 Acinetobacter baumannii in a Swedish Burn Center

Objective: To describe the course of the outbreak and adjacent multimodal interventions taken to stop the outbreak of multidrug-resistant clonal complex sequence type 15 Acinetobacter baumannii in the Burn Center of Uppsala University Hospital, between November 2014 and the end of April 2015.Methods: Sampling from patients and environment were established and cultured for A. baumannii. Antibiotic susceptibility testing was performed on all A. baumannii isolates, and the epidemiological relationship was analysed for all carbapenem-resistant A. baumannii isolates using pulsed-field gel electrophoresis (PFGE). Further, carbapenem resistance was verified by check-points arrays. Interventions to combat the outbreak were stricter hygiene and cleaning routines, disposal of broken materials, information, and education.Results: A total of 54 patients were treated at the burn intensive care unit during the studied five-month period and in nine patients (9/54, 17 %) cultures were positive for a blaOXA-23-producing A. baumannii. The infection with A. baumannii led to a fatal outcome for two patients (2/9, 22.2%): of these two patients one suffered from bacteraemia leading to sepsis, and one from serious ventilator-associated pneumonia. All isolates shared identical PFGE-genotype patterns and were regarded as related to the outbreak. Interventions that were deemed to be successful were strict compliance to hygiene routines, cleaning and education.Conclusions: This is one of the first described outbreak of a carbapenem-resistant A. baumannii in Scandinavia and might serve as a serious warning to healthcare professionals to strictly obey hand hygiene routines and dress codes and other successful interventions.