0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Nosocomial Acinetobacter baumannii Infections: Microbiological and Clinical Epidemiology

Daniel Villers, MD; Eric Espaze, MD; Marianne Coste-Burel, PharmD; Frederic Giauffret, MD; Emmanuelle Ninin, MD; Francoise Nicolas, MD; and Herve Richet, MD
[+] Article and Author Information

From the Institut de Biologie des Hopitaux de Nantes and Hotel Dieu, Nantes, France. Acknowledgments: The authors thank Jerome Tokars, MD, MPH, for manuscript review and assistance with data analysis and Dominique Gautreau, Anny Blin, and Michele Fleury for technical assistance. Grant Support: In part by grant 931305 from the Institut National de la Sante et de la Recherche Medicale. Requests for Reprints: Daniel Villers, MD, Service de Reanimation Medicale, Hotel Dieu, Centre Hospitalier Universitaire de Nantes, 44035 Nantes Cedex 01, France. Current Author Addresses: Drs. Villers, Giauffret, and Nicolas: Service de Reanimation Medicale, Hotel Dieu, Centre Hospitalier Universitaire de Nantes, 44035 Nantes Cedex 01, France. Drs. Espaze, Coste-Burel, Ninin, and Richet: Laboratoire de Bacteriologie, Virologie, Hygiene Hospitaliere, Institut de Biologie des Hopitaux de Nantes, 9, Quai Moncousu, 44035 Nantes Cedex 01, France.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;129(3):182-189. doi:10.7326/0003-4819-129-3-199808010-00003
Text Size: A A A

Background: Acinetobacter baumannii is an important opportunistic pathogen that is rapidly evolving toward multidrug resistance and is involved in various nosocomial infections that are often severe. It is difficult to prevent A. baumannii infection because A. baumannii is ubiquitous and the epidemiology of the infections it causes is complex.

Objective: To study the epidemiology of A. baumannii infections and assess the relation between fluoroquinolone use and the persistence of multidrug-resistant clones.

Design: Three case–control studies and a retrospective cohort study.

Setting: A 20-bed medical and surgical intensive care unit.

Patients: Acinetobacter baumannii was isolated from 45 patients in urine (31%), the lower respiratory tract (26.7%), wounds (17.8%), blood (11.1%), skin (6.7%), cerebrospinal fluid (4.4%), and sinus specimens (2.2%). One death was due to A. baumannii infection.

Measurements: Antimicrobial resistance pattern and molecular typing were used to characterize isolates. The incidence of A. baumannii infection and the use of fluoroquinolones were calculated annually.

Results: Initially, 28 patients developed A. baumannii infection. Eleven isolates had the same antimicrobial susceptibility profile, genotypic profile, or both (epidemic cases), and 17 were heterogeneous (endemic cases). A surgical procedure done in an emergency operating room was the main risk factor for epidemic cases, whereas previous receipt of a fluoroquinolone was the only risk factor for endemic cases. The opening of a new operating room combined with the restriction of fluoroquinolone use contributed to a transitory reduction in the incidence of infection. When a third epidemiologic study was done, previous receipt of a fluoroquinolone was again an independent risk factor and a parallel was seen between the amount of intravenous fluoroquinolones prescribed and the incidence of endemic infection.

Conclusion: Epidemic infections coexisted with endemic infections favored by the selection pressure of intravenous fluoroquinolones.

Figures

Grahic Jump Location
Figure 1.
Ribotype patterns of Acinetobacter baumannii strains after EcoR1 digestion and hybridization with the labeled pKK3535 riboprobe.

Lanes A, B, C, and D: Raoul 1 size marker; lanes 1 through 7: pattern R1 (epidemic strains); lanes 8 through 14: pattern R2 (endemic strains from the second and third case–control studies); and lanes 15 and 16: sporadic strains. Kb = kilobase pairs.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Repetitive polymerase chain reaction patterns of Acinetobacter baumannii after digestion with ERIC II.Figure 1

Lanes A, B, and C: 1-kilobase DNA ladder size marker. Lanes 1 through 16: Isolates are shown in the same order as in . Bp = base pairs.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Epidemic curve.Acinetobacter baumannii

infections in an intensive care unit, 1989-1993. OR = operating room.

Grahic Jump Location
Grahic Jump Location
Figure 4.
Amount of fluoroquinolones given (white bars) compared with incidence of Acinetobacter baumannii infections per admission (solid line) in an intensive care unit, 1991-1994.
Grahic Jump Location
Grahic Jump Location
Figure 5.
Mode of fluoroquinolone administration compared with incidence of Acinetobacter baumannii infections per admission (solid line) in patients in an intensive care unit, 1991-1994.

White bars represent oral administration of fluoroquinolone; striped bars represent intravenous administration of fluoroquinolone.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)