Clinical Features and Epidemiology of <i>Acinetobacter baumannii</i> Colonization and Infection in Spanish Hospitals

Rodríguez-Baño, Jesús; Cisneros, José Miguel; Fernández-Cuenca, Felipe; Ribera, Anna; Vila, Jordi; Pascual, Álvaro; Martínez-Martínez, Luis; Bou, Germán; Pachón, Jerónimo; Hospitalaria, Grupo de Estudio de Infección

doi:10.1086/502302

Cited by 126 publications

(91 citation statements)

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“…For hospitals H3 and H4, one of the coexisting clones was clearly in the minority. This might reflect the coexistence of sporadic and epidemic clones (30). Hospital H19 had three clones (clones D1, D5, and G3) isolated from the cardiology ward, which might reflect a low level of nosocomial infection control in this unit.…”

Section: Discussionmentioning

confidence: 99%

Clonal Diversity of Nosocomial Epidemic Acinetobacter baumannii Strains Isolated in Spain

et al. 2011

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Acinetobacter baumannii is one of the major pathogens involved in nosocomial outbreaks. The clonal diversity of 729 epidemic strains isolated from 19 Spanish hospitals (mainly from intensive care units) was analyzed over an 11-year period. Pulsed-field gel electrophoresis (PFGE) identified 58 PFGE types that were subjected to susceptibility testing, rpoB gene sequencing, and multilocus sequence typing (MLST). All PFGE types were multidrug resistant; colistin was the only agent to which all pathogens were susceptible. The 58 PFGE types were grouped into 16 clones based on their genetic similarity (cutoff of 80%). These clones were distributed into one major cluster (cluster D), three medium clusters (clusters A, B, and C), and three minor clusters (clusters E, F, and G). Multidrug-resistant Acinetobacter baumannii is a bacterium frequently endemic in certain hospital wards and is responsible for numerous nosocomial outbreaks around the world (3,23,33). Its great capacity to survive in low-moisture environments and its ability to develop resistance to antimicrobial agents afford A. baumannii the possibility of spreading in hospitals. The skin, oropharynx, and digestive tract are the main body areas colonized in hospitalized patients. The risk of colonization and subsequent infection are associated with factors such as the presence of underlying severe illnesses, long-term hospitalization, stays in specific hospital wards, selective antimicrobial pressure, and invasive interventions such as the use of mechanical ventilation or catheters (4,12,14,18).Nosocomial outbreaks of A. baumannii can have their origin in a single reservoir or in multiple contaminated sites (37, 39), and infection can have serious repercussions for patient morbidity and mortality. Patients can acquire the bacterium from an environmental source or from other patients (6, 18).The clonal study of hospital strains is very important in terms of an understanding of the epidemiology of these outbreaks. The aim of the present work was therefore to analyze the genetic diversity and clonal distribution of epidemic strains of A. baumannii isolated from around Spain over a long period of time. Isolates collected during outbreaks at different hospitals were analyzed by pulsed-field gel electrophoresis (PFGE), sequencing of the RNA polymerase ␤ subunit (rpoB) gene, and multilocus sequence typing (MLST). The results were then compared. Antimicrobial susceptibility testing was also performed to determine the multidrug resistance phenotypes of these epidemic strains. MATERIALS AND METHODSBacterial strains. Over the 11-year period from 1997 to 2007, an initial 814 A. baumannii strains isolated from clinical settings and suspected of being involved in nosocomial outbreaks were sent to the Spanish National Center for Microbiology (CNM) for typing. Strains were isolated from 19 public hospitals in 17 Spanish provinces. Hospitals were coded H1 to H19, and provinces were coded P1 to P17. The type of clinical sample, the hospital ward of origin, and the isolation per...

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Section: Discussionmentioning

confidence: 99%

Clonal Diversity of Nosocomial Epidemic Acinetobacter baumannii Strains Isolated in Spain

et al. 2011

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“…For each patient and each sample, clinical data were accessed through the hospital online patient database. The criterion for infection versus colonization was interpreted as per Center for Disease Control and Prevention (CDC) guidelines [22]. The isolate was considered as multidrug resistant, if resistant to more than two classes of antimicrobials or to carbapenems.…”

Section: Materials Methodsology and Set Upmentioning

confidence: 99%

Patient Demographics and Characteristics of Infection with Carbapenem-Resistant <i>Acinetobacter baumannii</i> in a Teaching Hospital from the United States

Vaze¹,

Emery²,

Hamilton³

et al. 2013

AID

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A characterization of the clinical demographic features of patients with infection caused Acinetobacter baumannii, and the antibiotyping of the isolates recovered from these patients was undertaken, with a special reference to carbapenemresistant variants, and their risk factors. This study was conducted retrospectively from January 2010 to March 2011 at a 616-bed tertiary care university hospital. Sixty-four patients were identified. Clinical and microbiological data were analyzed for risk factors and demographic features to derive relative risk and odds ratio. We identified 100 A. baumannii from 64 patients during 15 months period. Significant risk factors were working age (18 -60 years), male gender, hospital stay (>1 week but <1 month), prior hospitalization, in a progressive care nursing units, respiratory/mechanical ventilation, polymicrobial infections and prior antibiotic therapy. Methicillin-resistant staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Klebsiella pneumoniae were the significant co-infecting agents. The antibiogram demonstrated multidrug resistance in a majority of the isolates. Relative risk associated with ventilator, diabetes, and surgery was higher in repeat isolates than in first isolates and were multidrug resistant. Repeat isolates were more resistant that the first isolates to most anti-acinetobacter agents, but the overall crude mortality was not significant during this study period, and couldn't correlated to the choice of treatment. In conclusion, a resistance against all clinically used carbapenems, and colistin is rapidly increasing in repeat isolates of A. baumannii; leaves narrow therapeutic options to treat multidrug-resistant and pandrug-resistant A. baumannii infection. For the first time we report rising incidence of colistin resistance by 20 percent in repeat isolates, and is worrisome for healthcare centers. A combination therapy should be adopted to treat such infection to avoid the emergence of colistin-resistant phenotypes in the United States.

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“…Thus, studies that do not use molecular techniques to distinguish A. baumannii from related Acinetobacter species may generate inaccurate data regarding clinical epidemiology and disease outcomes. Second, A. baumannii often colonizes rather than infects patients, thereby obscuring the true significance of organism isolation (25). Finally, given that patients are often critically ill at the time of infection with A. baumannii, whether A. baumannii infection actually increases patient mortality has been debated (11,18,20).…”

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Sequential Outbreaks of Infections by Distinct Acinetobacter baumannii Strains in a Public Teaching Hospital in Houston, Texas

et al. 2008

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Invasive disease due to Acinetobacter baumannii is an increasing problem in health care settings worldwide. Whether certain clones of A. baumannii are more likely to cause invasive disease in hospitalized patients is unknown. We studied all patients at a public teaching hospital in Houston, Texas, from whom the Acinetobacter calcoaceticus-Acinetobacter baumannii complex was isolated over a 14-month period in 2005 to 2006. One hundred seven unique patient isolates were identified, with 87 of the strains classified as being A. baumannii, the majority of which were multidrug resistant. The A. baumannii isolates were comprised of 18 unique pulsed-field types, with strains of clone A and clone B accounting for 66 of the 87 isolates. Epidemiologic analysis showed the predominance of the two A. baumannii clones at distinct time periods, with the remainder of the A. baumannii and non-A. baumannii strains being evenly distributed. Patients from whom clone A strains were isolated were more likely to be bacteremic than were patients with other A. baumannii isolates. Conversely, clone B strains were more likely to be isolated from patients with tertiary peritonitis. Patients from whom clone A was isolated had a significantly higher rate of mortality. Multilocus sequence typing demonstrated that clones A and B are related to each other and to A. baumannii strains previously isolated in Western Europe, sharing five of seven alleles. Taken together, we conclude that the outbreak of the A. calcoaceticus-A. baumannii complex in our institution was due to two distinct A. baumannii clones that were associated with significantly different patient outcomes.

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

Abstract: 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.

Cited by 126 publications

References 28 publications

Clonal Diversity of Nosocomial Epidemic Acinetobacter baumannii Strains Isolated in Spain

Clonal Diversity of Nosocomial Epidemic Acinetobacter baumannii Strains Isolated in Spain

Patient Demographics and Characteristics of Infection with Carbapenem-Resistant <i>Acinetobacter baumannii</i> in a Teaching Hospital from the United States

Sequential Outbreaks of Infections by Distinct Acinetobacter baumannii Strains in a Public Teaching Hospital in Houston, Texas

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

Abstract: 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.

Cited by 126 publications

References 28 publications

Clonal Diversity of Nosocomial Epidemic Acinetobacter baumannii Strains Isolated in Spain

Clonal Diversity of Nosocomial Epidemic Acinetobacter baumannii Strains Isolated in Spain

Patient Demographics and Characteristics of Infection with Carbapenem-Resistant &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; in a Teaching Hospital from the United States

Sequential Outbreaks of Infections by Distinct Acinetobacter baumannii Strains in a Public Teaching Hospital in Houston, Texas

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Patient Demographics and Characteristics of Infection with Carbapenem-Resistant <i>Acinetobacter baumannii</i> in a Teaching Hospital from the United States