Epidemiologic and clinical impact of Acinetobacter baumannii colonization and infection: a reappraisal.

Abstract

Acinetobacter baumannii is one of the most important antibiotic-resistant nosocomial bacteria. We investigated changes in the clinical and molecular epidemiology of A. baumannii over a 10-year period. We compared the data from 2 prospective multicenter cohort studies in Spain, one performed in 2000 (183 patients) and one in 2010 (246 patients), which included consecutive patients infected or colonized by A. baumannii. Molecular typing was performed by repetitive extragenic palindromic polymerase chain reaction (REP-PCR), pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). The incidence density of A. baumannii colonization or infection increased significantly from 0.14 in 2000 to 0.52 in 2010 in medical services (p < 0.001). The number of non-nosocomial health care-associated cases increased from 1.2% to 14.2%, respectively (p < 0.001). Previous exposure to carbapenems increased in 2010 (16.9% in 2000 vs 27.3% in 2010, p = 0.03). The drugs most frequently used for definitive treatment of patients with infections were carbapenems in 2000 (45%) and colistin in 2010 (50.3%). There was molecular-typing evidence of an increase in the frequency of A. baumannii acquisition in non-intensive care unit wards in 2010 (7.6% in 2000 vs 19.2% in 2010, p = 0.01). By MSLT, the ST2 clonal group predominated and increased in 2010. This epidemic clonal group was more frequently resistant to imipenem and was associated with an increased risk of sepsis, although not with severe sepsis or mortality. Some significant changes were noted in the epidemiology of A. baumannii, which is increasingly affecting patients admitted to conventional wards and is also the cause of non-nosocomial health care-associated infections. Epidemic clones seem to combine antimicrobial resistance and the ability to spread, while maintaining their clinical virulence.

• Authors: Macarena Villar, María E Cano, Eva Gato, José Garnacho-Montero, José Miguel Cisneros, Carlos Ruíz de Alegría, Felipe Fernández-Cuenca, Luis Martínez-Martínez, Jordi Vila, Alvaro Pascual, María Tomás, Germán Bou, Jesús Rodríguez-Baño, GEIHGEMARAREIPI-Ab20101 Group
• Journal: Medicine (Medicine (Baltimore)) Vol. 93 Issue 5 Pg. 202-210 (Jul 2014) ISSN: 1536-5964 [Electronic] United States
• PMID: 25181313 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Carbapenems
• Colistin

Topics

• Acinetobacter Infections (diagnosis, drug therapy, epidemiology, physiopathology)
• Acinetobacter baumannii (classification, drug effects, isolation & purification, pathogenicity)
• Aged
• Anti-Bacterial Agents (pharmacology)
• Bacterial Typing Techniques
• Carbapenems (pharmacology)
• Cohort Studies
• Colistin (pharmacology)
• Colony Count, Microbial (methods)
• Cross Infection (diagnosis, drug therapy, epidemiology, microbiology, physiopathology)
• Drug Resistance, Bacterial
• Electrophoresis, Gel, Pulsed-Field (methods)
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Spain (epidemiology)