Sporadic examples of infection with multi-resistant spp. have occurred in Nottingham hospitals since at least 1977, punctuated by more prolonged outbreaks involving larger numbers of patients, particularly those confined to the intensive therapy unit (ITU) with severe underlying disease. In the most recent outbreak, 11 patients were infected with multi-resistant strains and 26 patients were colonised. Four of the infected patients died directly or indirectly from infection with multi-resistant spp., either while in the ITU or after discharge to a general ward. The mean interval from admission to the first isolation of a multi-resistant strain was 6·7 and 12·1 days in the infected and colonised groups, respectively. Multi-resistant Acinetobacter strains were isolated most frequently from the respiratory tract, and eight patients had probable or suspected pneumonia caused by a multi-resistant sp. All infected patients were treated with imipenem, with or without an aminoglycoside, except one patient who died before a diagnosis of acinetobacter infection was confirmed. Multi-resistant spp. were isolated from various environmental sites in the ITU, and patient and environmental isolates were found to be related closely by biotyping, antibiograms, pulsed-field gel electrophoresis of chromosomal fingerprints and ribotyping. The outbreak was controlled ultimately by transfer of infected or colonised patients to an isolation cubicle, cohort nursing, emphasis on the importance of hand washing before and after patient contact and when handling case notes, and the use of disposable aprons and gowns during patient contact. These measures were combined with closure of the ITU for decontamination purposes on two separate occasions. Continued surveillance of ITU patients and occasional environmental sampling has proved to be important in preventing and controlling subsequent outbreaks of infection by this increasingly important nosocomial pathogen.


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