Containing Multi-Drug-Resistant Organisms in a Long-Term Acute-Care Hospital

FLORIDA DEPARTMENT OF HEALTH IN ORANGE COUNTY

When a novel multi-drug-resistant organism (MDRO) was discovered in a patient at a long-term acute-care hospital in Orange County, Florida, the health department began a rapid response to investigate its source and contain its spread. The patient was colonized with a form Pseudomonas aeruginosa that was producing VIM (Verona integron-encoded metallo-beta-lactamase), an enzyme that makes it resistant to a class of antibiotics normally highly effective against antibiotic-resistant bacteria. This was Florida’s first reported case of this “superbug”—known as VIM-CRPA—and immediate containment was necessary.

The Florida Department of Health in Orange County (DOH-Orange) launched extensive screening throughout the facility, with support from CDC. Investigators performed direct observations of patient care, hand hygiene, personal protective equipment use, and environmental cleaning; conducted environmental sampling; and oversaw collection of rectal swabs from patients for screening. The Southeast Regional Antibiotic Resistance Laboratory Network performed antimicrobial resistance testing and genotyping on specimens. In the process, the investigators discovered that the facility had a concurrent outbreak of a different MDRO, Klebsiella pneumoniae carbapenemase-producing carbapenem-resistant Enterobacteriaceae (KPC-CRE).

To assess regional spread, DOH-Orange performed a social network analysis and extended the containment response to other high-risk healthcare facilities, where more cases were discovered. By the outbreak’s end, the investigation had uncovered 9 cases of VIM-CPRA, 44 cases of KPC-CRE, and 6 cases of co-infection. DOH-Orange’s containment efforts ultimately stopped the transmission of VIM-CRPA and the outbreak ended.

To learn about the tools DOH-Orange created to assist with the response and to read other highlights from the field, visit Field Notes on CDC’s Public Health Professionals Gateway.