Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-19T11:33:01.771Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical Features and Epidemiology of Acinetobacter baumannii Colonization and Infection in Spanish Hospitals

Published online by Cambridge University Press:  02 January 2015

Jesús Rodríguez-Baño ,
Jose M. Cisneros ,
Felipe Fernández-Cuenca ,
Anna Ribera ,
Jordi Vila ,
Alvaro Pascual ,
Luis Martínez-Martínez ,
Germán Bou ,
Jerónimo Pachón  and
Grupo de Estudio de Infección Hospitalaria (GEIH)
Jesús Rodríguez-Baño*
Affiliation:
Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla, Spain
Jose M. Cisneros
Affiliation:
Servicio de Enfermedades Infecciosas, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain
Felipe Fernández-Cuenca
Affiliation:
Servicio de Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
Anna Ribera
Affiliation:
Servicio de Microbiología, Hospital Clinic, Barcelona, Spain
Jordi Vila
Affiliation:
Servicio de Microbiología, Hospital Clinic, Barcelona, Spain
Alvaro Pascual
Affiliation:
Servicio de Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
Luis Martínez-Martínez
Affiliation:
Servicio de Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
Germán Bou
Affiliation:
Servicio de Microbiología, Hospital Juan Canalejo, La Coruña, Spain
Jerónimo Pachón
Affiliation:
Servicio de Enfermedades Infecciosas, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain
*
Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Avda Dr Fedriani, 3, 41071 Sevilla, Spain
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To investigate the clinical features and the epidemiology of Acinetobacter baumannii in Spanish hospitals.

Design:

Prospective multicenter cohort study.

Setting:

Twenty-seven general hospitals and one paraplegic center in Spain.

Methods:

All cases of A. baumannii colonization or infection detected by clinical samples during November 2000 were included. Isolates were identified using phenotypic and genotypic methods. The molecular relatedness of the isolates was assessed by pulsed-field gel electrophoresis.

Results:

Twenty-five (89%) of the hospitals had 221 cases (pooled rate in general hospitals, 0.39 case per 1,000 patient-days; range, 0 to 1.17). The rate was highest in intensive care units (ICUs). Only 3 cases were pediatric. The mean age of the patients in the general hospitals was 63 years; 69% had a chronic underlying disease and 80% had previously received antimicrobial treatment. Fifty-three percent of the patients had an infection (respiratory tract, 51%; surgical site, 16%; and urinary tract, 11%). Crude mortality was higher in infected than in colonized patients (27% vs 10%; relative risk, 1.56; 95% confidence interval, 1.2 to 2.0; P = .003). Molecular analysis disclosed 79 different clones. In most hospitals, a predominant epidemic clone coexisted with other sporadic clones. Imipenem resistance was present in 39% of the hospitals.

Conclusions:

A. baumannii was present in most participating Spanish hospitals (particularly in ICUs) with different rates among them. The organisms mainly affected predisposed patients; half of them were only colonized. Epidemic and sporadic clones coexisted in many centers.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 10 , October 2004 , pp. 819 - 824
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Gales, AC, Jones, RN, Forward, KR, Liñares, J, Sader, HS, Verhoef, J. Emerging importance of multidrug-resistant Acinetobacter species and Stenotrophomonas maitophilia as pathogens in seriously ill patients: geographic patterns, epidemiological features, and trends in the SENTRY Antimicrobial Surveillance Program (1997-1999). Clin Infect Dis 2001;32(suppl 2):S104–S113.Google Scholar
2. Bergogne-Bérézin, E, Towner, KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996;9:148–165.10.1128/CMR.9.2.148Google Scholar
3. Afzal-Shah, M, Livermore, DM. Worldwide emergence of carbapenem-resistant Acinetobacter spp. J Antimicrob Chemother 1998;41:576–577.10.1093/jac/41.5.576Google Scholar
4. Jones, ME, Thornsberry, C, Livermore, DM, Sahm, DF. Prevalence of Acinetobacter spp. isolates with reduced susceptibility to imipenem, as determined by a USA-wide electronic surveillance network. J Antimicrob Chemother 1999;43:429–431.10.1093/jac/43.3.429Google Scholar
5. Villers, D, Espaze, E, Coste-Burel, M, et al. Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med 1998;129:182–189.10.7326/0003-4819-129-3-199808010-00003Google Scholar
6. Vahaboglu, H, Öztürk, R, Aygün, G, et al. Widespread detection of PER-1-type extended-spectrum beta-lactamases among nosocomial Acinetobacter and Pseudomonas aeruginosa isolates in Turkey: a nationwide mulücenter study. Antimicrob Agents Chemother 1997:41:2265–2269.10.1128/AAC.41.10.2265Google Scholar
7. Sader, HS, Mendes, CF, Pignatari, AC, Pfaller, MA. Use of macrorestriction analysis to demonstrate interhospital spread of multiresistant Acinetobacter baumannii in Sao Paulo, Brazil. Clin Infect Dis 1996;23:631–634.10.1093/clinids/23.3.631Google Scholar
8. Manikal, VM, Landman, D, Saurina, G, Oydna, E, Lal, H, Quale, J. Endemie carbapenem-resistant Acinetobacter species in Brooklyn, New York: citywide prevalence, interinstitutional spread, and relation to antibiotic usage. Clin Infect Dis 2000;31:101–106.10.1086/313902Google Scholar
9. Landman, D, Quale, JM, Mayorga, D, et al. Citywide clonal outbreak of multiresistant Acinetobacter baumannii and Pseudomonas aeruginosa in Brooklyn, NY: the preantibiotic era has returned. Arch Intern Med 2002:162:1515–1520.10.1001/archinte.162.13.1515Google Scholar
10. McCabe, WR, Jackson, GG. Gram-negative bacteremia: I. Etiology and ecology. Arch Intern Med 1962;110:847–855.10.1001/archinte.1962.03620240029006Google Scholar
11. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.10.1016/0196-6553(88)90053-3Google Scholar
12. Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.10.2307/30148464Google Scholar
13. Bone, RC, Balk, RA, Cerra, FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992;101:1644–1655.10.1378/chest.101.6.1644Google Scholar
14. Vaneechoutte, M, Dijkshoorn, L, Tjernberg, I, et al. Identification of Acinetobacter genomic species by amplified ribosomal DNA restriction analysis. J Clin Microbiol 1995;33:11–15.Google Scholar
15. Allardet-Servent, A, Bouziges, N, Carles-Nurit, MJ, Bourg, G, Gouby, A, Ramuz, M. Use of low-frequency-cleavage restriction endonucleases for DNA analysis in epidemiological investigations of nosocomial bacterial infections. J Clin Microbiol 1989;27:2057–2061.10.1128/jcm.27.9.2057-2061.1989Google Scholar
16. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.10.1128/jcm.33.9.2233-2239.1995Google Scholar
17. National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacterial That Grow Aerobically. Wayne, PA: National Committee for Clinical Laboratory Standards; 2000. Approved standard M7-A5.Google Scholar
18. Villari, P, Iacuzio, L, Vozzella, EA, Bosco, U. Unusual genetic heterogeneity of Acinetobacter baumannii isolates in a university hospital in Italy. Am J Infect Control 1999;27:247–253.10.1053/ic.1999.v27.a96961Google Scholar
19. Martinez-Pelliis, A, Ruiz Gómez, J, Jaime Sánchez, F, Simarro Córdoba, E, Fernández Ixizano, JA. Incidence of colonization and infection by Acinetobacter baumannii in an endemic setting (ICU): analysis of risk factors by means of a surveillance study [in Spanish]. Enferm Infecc Microbiol Clin 2002;20:194–199.Google Scholar
20. Rodriguez Baño, J, Pascual, A, Calvez, J, et al. Acinetobacter baumannii bacteremia: clinical and prognostic features [in Spanish]. Enferm Infecc Microbiol Clin 2003;21:242–246.Google Scholar
21. McDonald, LC, Banerjee, SN, Jarvis, WR. Seasonal variation of Acinetobacter infections: 1987-1996. Clin Infect Dis 1999;29:1133–1137.10.1086/313441Google Scholar
22. Thurm, V, Ritter, E. Genetic diversity and clonal relationships of Acinetobacter baumannii strains isolated in a neonatal ward: epidemiological investigations by allozyme, whole-cell protein and antibiotic resistance analysis. Epidemiol Infect 1993;111:491–498.10.1017/S0950268800057228Google Scholar
23. Nagels, B, Ritter, E, Thomas, P, Schulte-Wissermann, H, Wirsing von Konig, CH. Acinetobacter baumannii colonization in ventilated preterm infants. Eur J Clin Microbiol Infect Dis 1998;17:37–40.10.1007/BF01584361Google Scholar
24. Huang, YC, Su, LH, Wu, TL, et al. Outbreak of Acinetobacter baumannii bacteremia in a neonatal intensive care unit: clinical implications and genotyping analysis. Pediatr Infect Dis J 2002;21:1105–1109.10.1097/00006454-200212000-00004Google Scholar
25. Melamed, R, Greenberg, D, Porat, N, et al. Successful control of an Acinetobacter baumannii outbreak in a neonatal intensive care unit. J Hosp Infect 2003;53:31–38.10.1053/jhin.2002.1324Google Scholar
26. Wise, Ka, Tosolini, FA. Epidemiological surveillance of Acinetobacter species . J Hosp Infect 1990;16:319–329.10.1016/0195-6701(90)90004-8Google Scholar
27. Pedraza, F, Andreu, A, Saune, M, Moreno, A, Ramirez, L, Garcia, L. A urinary outbreak of Acinetobacter baumannii in a spinal cord injury unit [in Spanish], An Med Interna 1993;10:55–58.Google Scholar
28. Marcos, MA, Abdalla, S, Pedraza, F, et al. Epidemiological markers of Acinetobacter baumannii clinical isolates from a spinal cord injury unit. J Hosp Infect 1994;28:39–48.10.1016/0195-6701(94)90151-1Google Scholar
29. Corbella, X, Pujol, M, Ayats, J, et al. Relevance of digestive tract colonization in the epidemiology of nosocomial infections due to multiresistant Acinetobacter baumannii . Clin Infect Dis 1996;23:329–334.10.1093/clinids/23.2.329Google Scholar
30. del Toro, MD, Rodriguez-Baño, J, Herrero, M, et al. Clinical epidemiology of Stenotrophomonas maltophilia colonization and infection: a multi-center study. Medicine (Baltimore) 2002;81:228–239.10.1097/00005792-200205000-00006Google Scholar
31. Koeleman, JG, van der Biji, MW, Stoof, J, Vanderbroucke-Grauls, CM, Savelkoul, PH. Antibiotic resistance is a major risk factor for epidemic behavior of Acinetobacter baumannii . Infect Control Hosp Epidemiol 2001;22:284–288.10.1086/501901Google Scholar