José Garnacho-Montero1, Antonio Gutiérrez-Pizarraya2, Ana Díaz-Martín3, José Miguel Cisneros-Herreros4, María Eugenia Cano5, Eva Gato5, Carlos Ruiz de Alegría5, Felipe Fernández-Cuenca6, Jordi Vila7, Luis Martínez-Martínez8, M Del Mar Tomás-Carmona9, Álvaro Pascual10, Germán Bou9, Jerónimo Pachón-Diaz4, Jesús Rodríguez-Baño10. 1. Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Spain; Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Spain. Electronic address: jgarnachom@gmail.com. 2. Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Spain. 3. Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Spain; Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Spain. 4. Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Virgen del Rocío, Spain. 5. Service of Microbiology, University Hospital Marqués de Valdecilla, Spain. 6. Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen Macarena Hospital, Spain. 7. Department of Clinical Microbiology, Hospital Clínic, Barcelona Centre for International Health Research, Barcelona, Spain. 8. Service of Microbiology, University Hospital Marqués de Valdecilla, Spain; IDIVAL, Department of Molecular Biology, University of Cantabria, Spain. 9. Microbiology Department, A Coruña University Hospital Complex, A Coruña, Spain. 10. Spanish Network for the Research in Infectious Diseases (REIPI), Spain; Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen Macarena Hospital, Spain.
Abstract
INTRODUCTION: The main aim of this study was to assess changes in the epidemiology and clinical presentation of Acinetobacter baumannii over a 10-year period, as well as risk factors of mortality in infected patients. METHOD: Prospective, multicentre, hospital-based cohort studies including critically ill patients with A. baumannii isolated from any clinical sample were included. These were divided into a first period ("2000 study") (one month), and a second period ("2010 study") (two months). Molecular typing was performed by REP-PCR, PFGE and MSLT. The primary endpoint was 30-day mortality. RESULTS: In 2000 and 2010, 103 and 108 patients were included, and the incidence of A. baumannii colonization/infection in the ICU decreased in 2010 (1.23 vs. 4.35 cases/1000 patient-days; p<0.0001). No differences were found in the colonization rates (44.3 vs. 38.6%) or infected patients (55.7 vs. 61.4%) in both periods. Overall, 30-day mortality was similar in both periods (29.1 vs. 27.8%). The rate of pneumonia increased from 46.2 in 2000 to 64.8% in 2010 (p<0.001). Performing MSLT, 18 different sequence types (ST) were identified (18 in 2000, 8 in 2010), but ST2 and ST79 were the predominant clones. ST2 isolates in the ICU increased from 53.4% in the year 2000 to 73.8% in 2010 (p=0.002). In patients with A. baumannii infection, the multivariate analysis identified appropriate antimicrobial therapy and ST79 clonal group as protective factors for mortality. CONCLUSIONS: At 10 years of the first analysis, some variations have been observed in the epidemiology of A. baumannii in the ICU, with no changes in mortality. Epidemic ST79 clone seems to be associated with a better prognosis and adequate treatment is crucial in terms of survival.
INTRODUCTION: The main aim of this study was to assess changes in the epidemiology and clinical presentation of Acinetobacter baumannii over a 10-year period, as well as risk factors of mortality in infectedpatients. METHOD: Prospective, multicentre, hospital-based cohort studies including critically illpatients with A. baumannii isolated from any clinical sample were included. These were divided into a first period ("2000 study") (one month), and a second period ("2010 study") (two months). Molecular typing was performed by REP-PCR, PFGE and MSLT. The primary endpoint was 30-day mortality. RESULTS: In 2000 and 2010, 103 and 108 patients were included, and the incidence of A. baumannii colonization/infection in the ICU decreased in 2010 (1.23 vs. 4.35 cases/1000 patient-days; p<0.0001). No differences were found in the colonization rates (44.3 vs. 38.6%) or infectedpatients (55.7 vs. 61.4%) in both periods. Overall, 30-day mortality was similar in both periods (29.1 vs. 27.8%). The rate of pneumonia increased from 46.2 in 2000 to 64.8% in 2010 (p<0.001). Performing MSLT, 18 different sequence types (ST) were identified (18 in 2000, 8 in 2010), but ST2 and ST79 were the predominant clones. ST2 isolates in the ICU increased from 53.4% in the year 2000 to 73.8% in 2010 (p=0.002). In patients with A. baumannii infection, the multivariate analysis identified appropriate antimicrobial therapy and ST79 clonal group as protective factors for mortality. CONCLUSIONS: At 10 years of the first analysis, some variations have been observed in the epidemiology of A. baumannii in the ICU, with no changes in mortality. Epidemic ST79 clone seems to be associated with a better prognosis and adequate treatment is crucial in terms of survival.
Authors: M López; A Rueda; J P Florido; L Blasco; L Fernández-García; R Trastoy; F Fernández-Cuenca; L Martínez-Martínez; J Vila; A Pascual; G Bou; M Tomas Journal: Sci Rep Date: 2018-02-06 Impact factor: 4.379