The Public Hospital 12 de Octubre in Madrid has been fighting a relentless battle for almost two years against a strain of the antibiotic-resistant Acinetobacter baumannii bacteria that is particularly deadly for people with suppressed immune systems. The outbreak began in February 2006 and took 20 months to control, affecting 252 patients, with 101 fatalities. According to the hospital’s investigation, 18 of these deaths were directly attributable to the bacteria, while in the rest, it was a contributing factor to the already critical condition of the patients.
The outbreak of acinetobacter at 12 de Octubre should not be used to cause alarm or question the medical care provided, but rather to learn from a significant problem affecting clinical activity worldwide: hospital infections by increasingly resistant bacteria. The hospital had to request permission to use a new antibiotic in response to the outbreak, as the bacteria had developed resistance to the existing treatment options, leaving the medical staff with limited options to combat the infection.
The ease with which the acinetobacter bacteria can spread and develop resistance to antibiotics became evident as the outbreak progressed. It spread from the ICU to other hospital services, such as internal medicine and surgical wards. The medical staff soon found themselves facing a strain of the bacteria that was resistant to nearly all available antibiotics, including the last resort medication, colistin. The hospital had to seek authorization to use tigecycline, a new antibiotic that was not yet commercially available.
Dealing with an outbreak of this nature can be a desperate situation, as the bacteria can survive on nearly any surface, making it challenging to contain. The measures recommended to curb the spread of the infection include isolating infected patients, administering antibiotics, and maintaining strict hygiene practices, such as thorough handwashing. Contaminated objects and surfaces must be thoroughly cleaned and prevented from coming into contact with other patients or staff members to prevent further spread of the bacteria.
The hospital faced difficulties due to a shortage of staff and resources, as reported by nursing staff and the labor union. Despite efforts to adhere to infection control protocols, the outbreak persisted for 20 months, resulting in the decision to relocate patients to other critical care units and completely rebuild the ICU to eliminate the bacteria. The final resort of temporarily closing the ICU and transferring patients to other hospitals was considered multiple times during the outbreak, but ultimately, the decision was made to rebuild the unit to prevent further contamination.
Overall, the hospital defended its response to the crisis and stated that mortality rates remained consistent during the outbreak. While challenges and shortcomings were noted by some staff members, the hospital maintained a united front in tackling the infection. The experience of dealing with the acinetobacter outbreak highlighted the importance of infection prevention measures, staff training, and adequate resources to effectively manage and control hospital-acquired infections caused by antibiotic-resistant bacteria.
