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A bronchofiberoscopy-associated outbreak of multidrug-resistant Acinetobacter baumannii in an intensive care unit in Beijing, China

Yukun Xia1, CuiLing Lu2, Jingya Zhao1, Gaige Han13, Yong Chen1, Fang Wang2, Bin Yi2, Guoqin Jiang1, Xiaohua Hu1, Xianfeng Du4, Zheng Wang4, Hong Lei2, Xuelin Han1 and Li Han1*

Author Affiliations

1 Department for Hospital Infection Control & Research, Institute of Disease Control & Prevention of People’s Liberation Army, Academy of Military Medical Sciences, Fengtai Dong Street 20, Beijing, China

2 309 hospital of the Chinese People’s Liberation Army, Beijing, China

3 Department of Microbiology, School of Basic Medical Sciences, Central South University, Changsha, Hunan, China

4 General Hospital of Chinese People’s Liberation Army, Beijing, China

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BMC Infectious Diseases 2012, 12:335  doi:10.1186/1471-2334-12-335

Published: 3 December 2012



Bronchofiberscopy, a widely used procedure for the diagnosis of various pulmonary diseases within intensive care units, has a history of association with nosocomial infections. Between September and November 2009, an outbreak caused by multidrug-resistant Acinetobacter baumannii (MDR-Ab) was observed in the intensive care unit of a tertiary care hospital in Beijing, China. This study is aimed to describe the course and control of this outbreak and investigate the related risk factors.


Clinical and environmental sampling, genotyping with repetitive extragenic palindromic polymerase chain reaction (REP-PCR), and case–control risk factor analysis were performed in the current study.


During the epidemic period, 12 patients were infected or colonized with MDR-Ab. Sixteen (72.7%) of twenty-two MDR-Ab isolates from the 12 patients and 22 (84.6%) of 26 MDR-Ab isolates from the bronchofiberscope and the healthcare-associated environment were clustered significantly into a major clone (outbreak MDR-Ab strain) by REP-PCR typing. Seven patients carrying the outbreak MDR-Ab strain were defined as the cases. Six of the seven cases (83%) received bronchofiberscopy versus four of the 19 controls (21%) (odds ratio, 22.5; 95% confidence interval, 2.07–244.84; P = 0.005). Several potential administrative and technical problems existed in bronchofiberscope reprocessing.


Bronchofiberscopy was associated with this MDR-Ab outbreak. Infection control precautions including appropriate bronchofiberscope reprocessing and environmental decontamination should be strengthened.

Outbreak; Bronchofiberscopy; Multidrug-resistant Acinetobacter baumannii