Publication: Colonización/infección por Acinetobacter baumannii multirresistente y resistente a carbapenémicos: epidemiología y factores predictivos de infección
Authors
Hernández-Torres, Alicia ; García-Vázquez, Elisa ; Gómez, Joaquín ; Canteras, Manuel ; Ruiz, Joaquín ; Fernández-Rufete, Ana ; Herreroa, José Antonio ; Yagüe, Genoveva
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Publisher
Elsevier
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DOI
https://doi.org/10.1016/j.medcli.2010.01.033
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info:eu-repo/semantics/article
Description
©2009 Elsevier España, S.L. Todos los derechos reservados. This document is the Published, version of a Published Work that appeared in final form in Medicina Clínica. To access the final edited and published work see https://doi.org/10.1016/j.medcli.2010.01.033
Abstract
RESUMEN:Fundamento y objetivo: Estudio de un brote de colonización/infección nosocomial por Acinetobacter baumannii multirresistente y resistente a carbapenémicos (ABMDR-C). Pacientes y método: Estudio prospectivo de pacientes con aislamiento de ABMDR-C entre enero de 2007 y junio de 2008. Se analizaron las características epidemiológicas y clínicas de los pacientes y los factores predictivos de infección frente a colonización.
Resultados: De 101 casos, 24 presentaban colonización y 77 presentaban infección (27 bacteriemia); la
mortalidad global (colonizaciones e infecciones) fue del 42% (4 colonizaciones y 38 infecciones [18
bacteriemias]). La incidencia de colonización/infección fue de 3,2/1.000 ingresos/día; un 29% tenía
antecedente de ingreso previo y un 79% había recibido antibióticos previos (carbapenémicos [29%],
piperacilina-tazobactam [34%] y ambos [12,5%]). El 78% tenía enfermedades de base, un 81% ingreso en la unidad de cuidados intensivos/reanimación, un 90% tuvo algún tipo de manipulación y un 65% presentaba coinfección por otros microorganismos. En el análisis multivariante fueron factores predictivos de infección frente a colonización: aislamiento de ABMDR-C en las muestras respiratorias (odds ratio [OR]:
5,406; intervalo de confianza [IC] del 95%: 1,419–20,599); sexo masculino (OR: 8,842; IC del 95%: 1,988–
39,325); ingreso previo (OR: 9,720; IC del 95%: 1,383–68,291) y gravedad clínica inicial (OR: 30,897; IC del
95%: 5,533–172,543).
Conclusiones: Nuestra cohorte de pacientes con colonizaciones/infecciones por ABMDR-C está constituida por pacientes con enfermedad de base crónica, a los que se les realizó distintas manipulaciones instrumentales, con ingresos hospitalarios previos y uso previo de betalactámicos de amplio espectro, especialmente carbapenémicos. Los pacientes tienen una alta gravedad clínica al comienzo y el aislamiento respiratorio es un importante factor predictor de infección frente a colonización.
ABSTRACT:Background and objective: To study an outbreak of nosocomial colonisation/infection due to multidrug and carbapenem resistant A. baumannii (ABMDR-C). Patients and methods: Prospective study of patients with ABMDR-C colonisation/infection (January 2007– June 2008). Epidemiological and clinical variables and predictors of infection versus colonization were analysed. Results: 24 out of 101 cases were considered colonisations and 77 infections (27 bacteraemia); global mortality (colonisations and infections) was 42% (4 colonisations and 38 infections -18 bacteraemia). All together, the incidence was 3.2/1000 admissions/day; 29% had been previously admitted and 79% had received previous antibiotic treatment (29% carbapenem; 34% piperacillin-tazobactam; 12.5% boths); 78% had an underlying condition; 81% were UCI patients; 90% had gone through invasive procedures; 65% had another microorganism isolated. In multivariate analysis, infection predictor factors were isolation of ABMDR-C in respiratory samples (OR 5.406; 95% CI 1.419–20.599); male patients (OR 8.842; 95% CI 1.988–39.325); previous hospitalization (OR 9.720; 95% CI 1.383–68.291) and initial clinical severity (OR 30.897; 95% CI 5.533–172.543). Conclusions: Our cohort of patients with ABMDR-C colonisation/infection is characterised by their underlying comorbidity, the high rate of previous invasive procedures, previous hospitalisation and previous broad-spectrum betalactam treatments (especially carbapenem). Initial severity and respiratory samples with ABMDR-C isolates were predictors of infection versus colonisation.
ABSTRACT:Background and objective: To study an outbreak of nosocomial colonisation/infection due to multidrug and carbapenem resistant A. baumannii (ABMDR-C). Patients and methods: Prospective study of patients with ABMDR-C colonisation/infection (January 2007– June 2008). Epidemiological and clinical variables and predictors of infection versus colonization were analysed. Results: 24 out of 101 cases were considered colonisations and 77 infections (27 bacteraemia); global mortality (colonisations and infections) was 42% (4 colonisations and 38 infections -18 bacteraemia). All together, the incidence was 3.2/1000 admissions/day; 29% had been previously admitted and 79% had received previous antibiotic treatment (29% carbapenem; 34% piperacillin-tazobactam; 12.5% boths); 78% had an underlying condition; 81% were UCI patients; 90% had gone through invasive procedures; 65% had another microorganism isolated. In multivariate analysis, infection predictor factors were isolation of ABMDR-C in respiratory samples (OR 5.406; 95% CI 1.419–20.599); male patients (OR 8.842; 95% CI 1.988–39.325); previous hospitalization (OR 9.720; 95% CI 1.383–68.291) and initial clinical severity (OR 30.897; 95% CI 5.533–172.543). Conclusions: Our cohort of patients with ABMDR-C colonisation/infection is characterised by their underlying comorbidity, the high rate of previous invasive procedures, previous hospitalisation and previous broad-spectrum betalactam treatments (especially carbapenem). Initial severity and respiratory samples with ABMDR-C isolates were predictors of infection versus colonisation.
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Citation
Med Clin (Barc). 2010 135(9):389-396
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