Bacterial outbreak at Shands has infected eight in burn unit
Published: Monday, July 29, 2013 at 6:17 p.m.
Last Modified: Monday, July 29, 2013 at 6:17 p.m.
A bacterial outbreak that struck the UF Health Shands Hospital's burn unit in March ultimately infected eight patients, the hospital's chief medical officer announced Monday, with one patient still in an isolation unit created in the outbreak's aftermath.
The hospital would not confirm Monday whether any deaths had occurred.
The bacteria, called acinetobacter baumannii, typically affect very sick patients and live on surfaces and in soil, Dr. Timothy Flynn said.
"It can literally be found anywhere," Flynn said. "Because of this, we've moved forward with plans to renovate the burn unit."
Flynn said the hospital, which already had planned to revamp the burn unit before the outbreak, closed it down but is still taking burn patients. Renovations on the unit should be complete in four to six months, he added.
Meanwhile, the hospital's infection control department is checking for contamination in other areas of the hospital, Flynn said.
While most patients can resist the bacteria, which cause potentially fatal infections such as ventilator-associated pneumonia and urinary tract infections, "patients who are highly immunocompromised, such as burn patients, are especially vulnerable," Flynn said.
The outbreak of acinetobacter baumannii at Shands mirrors a growing trend across the country and world of antibiotic-resistant bacteria causing deadly infections in hospitals' sickest patients. Dr. Brad Spellberg, an infectious disease expert at UCLA, estimates there are roughly 50,000 cases of this bacteria annually in the U.S., and 20 times that in the world. It is also common in returning troops from Afghanistan and Iraq, many of whom were contaminated through soil.
In hospitals, the bacteria often are transmitted from devices such as IVs, urine catheters and blood pressure cuffs, said Dr. Alex Kallen, an infectious disease specialist at the Centers for Disease Control and Prevention in Atlanta.
Kallen said hospital and hygiene also play a role. For example, health care workers who change the dressings on two different patients without first washing their hands can transmit it.
"Uncleaned medical equipment can play a huge role," Kallen said. "Most places that have a problem with this require a reassessment of cleaning within the rooms.
"It is a very hearty organism and can survive in an environment for a very long time," he continued.
Once detected, it is very hard to treat, since it resists all but one known antibiotic on the market, and that drug, known as Colistin, has serious side effects, namely complications to the kidney, said Dr. Glenn Morris, the director of the Emerging Pathogens Institute at UF and the interim epidemiologist at Shands Hospital.
"In this case we did use it (Colistin) where we had to," Morris said. "We weren't able to successfully treat patients with Colistin."
Flynn said many of the infected patients have been discharged, however.
"We think we have it under control," Morris added.
He explained that this bacteria is "one of the banes of our existence — this is a microorganism that is very resistant to antibiotics. It is relatively common for hospitals to encounter problems with this microorganism."
Part of the reason for this problem, Morris continued, is that "no new antibiotics are being developed, and we are starting to see with increasing frequency these resistant bacteria."
According to the CDC, more than 70 percent of the bacteria in hospital-associated infections are resistant to antibiotics.
The over-usage of antibiotics is primarily to blame for resistance to them, Morris continued. "For 50, 60 years we had these miracle drugs that could cure any infection, and we got very cavalier about them. What's happened is that we are using a lot of antibiotics for things that don't need them, driving the emergence of resistance."
Another problem is that drug companies are not as financially incentivized to create new antibiotics compared to, say, blood pressure medications, where they are guaranteed bigger profits, Morris said.
That leaves hospitals struggling to contain infections that invariably enter their doors.
"Periodically, we will admit a patient with acinetobacter baumannii. The problem is if the patient goes to the ICU, we always worry that other patients might acquire it … in this case, unfortunately it showed up at the burn unit, which is probably the worst place it can be."
He said the hospital moved quickly to shut down the unit and move the infected patients to an isolation unit. Meanwhile, Morris and colleagues are working on tracing the origin of the bacteria to see how it got inside the burn unit. This involves DNA fingerprinting of the bacteria, which oftentimes have several strains, each with their own fingerprint.
They might be able to tell if the various strains have a common source, Morris said, adding, "You are actually able to time when the bacteria entered (the hospital)."
A team of researchers at the National Institutes of Health did this as well, to retrace the occurrence of the outbreak of the bacteria KPC klebsiella, which in 2011 infected 18 patients at the NIH Clinical Center Hospital, killing nine of them.
With the recent outbreak at Shands, however, "it's still not clear" whether they will be able to determine the original source of infection and when it entered the hospital, Morris said.
Public health concerns?
Although acinetobacter baumannii typically affects only very sick patients, it can be transmitted to other patients who have been exposed to it on a medical device, such as a blood pressure cuff.
"If they're in the hospital and they have medical devices, they are potentially at risk," said Kallen of the CDC.
These healthier patients might not develop an infection, but if the bacteria live on them — say on the surface of the skin, or in the GI tract — they still can be a carrier of the bacteria to other, sicker patients, he added.
For that reason, they are working to develop surveillance cultures to test people who might be carriers without being overtly affected themselves, Kallen said.
Meanwhile, Morris said he encourages patients to avoid the hospital if possible.
"I don't like to see patients in the hospital — the fact remains that sometimes we do see these strains in the hospital and unfortunately we don't have good new antibiotics to treat them," he said.
"I like to try to get them out as quickly as possible."
Contact Kristine Crane at 338-3119, or firstname.lastname@example.org.