An outbreak of multidrug-resistant Pseudomonas aeruginosa associated with increased risk of patient death in an intensive care unit

OBJECTIVE: To investigate an outbreak of multidrug-resistant Pseudomonas aeruginosa in an intensive care unit (ICU). DESIGN: Epidemiologic investigation, environmental assessment, and ambidirectional cohort study. SETTING: A secondary-care university hospital with a 10-bed ICU. PATIENTS: All patients admitted to the ICU receiving ventilator treatment from December 1, 1999, to September 1, 2000. RESULTS: An outbreak in an ICU with multidrug-resistant isolates of P aeruginosa belonging to one amplified fragment-length polymorphism (AFLP)-defined genetic cluster was identified, characterized, and cleared. Molecular typing of bacterial isolates with AFLP made it possible to identify the outbreak and make rational decisions during the outbreak period. The outbreak included 19 patients during the study period. Infection with bacterial isolates belonging to the AFLP cluster was associated with reduced survival (odds ratio, 5.26; 95% confidence interval, 1.14 to 24.26). Enhanced barrier and hygiene precautions, cohorting of patients, and altered antibiotic policy were not sufficient to eliminate the outbreak. At the end of the study period (in July), there was a change in the outbreak pattern from long (December to June) to short (July) incubation times before colonization and from primarily tracheal colonization (December to June) to primarily gastric or enteral (July) colonization. In this period, the bacterium was also isolated from water taps. CONCLUSION: Complete elimination of the outbreak was achieved after weekly pasteurization of the water taps of the ICU and use of sterile water as a solvent in the gastric tubes.