Invasion of superbugs: Cockroach-driven outbreak of multidrug-resistant Enterobacter in an ICU

Abstract Objective: To describe factors in an outbreak of multidrug-resistant Enterobacter cloacae (MRE) in an intensive care unit (ICU) over a 20-month period including the likely contribution of cockroaches to the outbreak. Design: This is a retrospective descriptive study. Setting: ICU in an urban hospital. Patients: All patients admitted to the ICU during the 20-month outbreak period were included in the study. Interventions: Infection prevention interventions included contact isolation, hand hygiene, dedicated patient equipment, environmental cultures, and pest control. Results: 25 patients were identified as being colonized or infected with MRE. Relatedness of the outbreak strain and strains found in cockroaches was demonstrated by pulse field gel electrophoresis. Standard IP interventions did not have an impact on the outbreak until pest control was added. Once additional pest control measures were put in place, the outbreak ended. Conclusions: Insects have a potential role in transmission of pathogens in hospitals and their role should be considered when outbreaks are being investigated.