Differential characteristics of Acinetobacter baumannii colonization and infection: risk factors, clinical picture, and mortality.

OBJECTIVES: The objectives of this study were to detect those characteristics that were specifically associated with infection or colonization by Acinetobacter baumannii, describe the clinical manifestations of those patients in whom the infection was detected in intensive care unit (ICU) or non-ICU wards, and analyze the prognosis-associated factors in patients from whom A. baumannii was isolated. PATIENTS AND METHODS: A sample of 122 patients from whom A. baumannii was recovered during an endemic period in a teaching hospital was included. Only those cases in which A. baumannii was recovered as the unique microbe were considered. Demographic data; ward of admission; intrinsic and extrinsic risk factors for infection or colonization; chronic underlying condition severity, as evaluated by the McCabe classification or Charlson index and Acute Physiology and Chronic Health Evaluation (APACHE) II score; and clinical manifestations were analyzed to differentiate specific characteristics of colonized or infected patients. Factors independently associated with the mortality at 30 days were also analyzed by Cox regression. RESULTS: A total of 73 (60%) patients were colonized and 49 (40%) individuals were infected with A. baumannii. A non-fatal McCabe class (when compared to ultimately and rapidly fatal), days of hospitalization prior to isolation of A. baumannii, and present ICU admission were associated with the diagnosis of infection. The more frequent clinical picture was respiratory infection (tracheobronchitis, 16 [33%] cases; pneumonia, 27 [55%] cases). Mortality at 30 days was 24% (n=29). A non-fatal McCabe class (Exp[B] 2.44, 95% confidence interval [CI] 1.05-5.66, p=0.039) and the absence of infection (Exp[B] 2.75, 95% CI 1.18-6.38, p=0.019) were independently associated with survival. CONCLUSION: Parameters associated with infection by A. baumannii in an endemic situation are the admission at ICU and the number of days of hospitalization. Mortality of patients from whom A. baumannii was isolated was independently influenced by the chronic underlying basal state and the presence of infection by A. baumannii.

Candidemias: análisis multicéntrico en 16 hospitales andaluces / Candidemias: multicentre analysis in 16 hospitals in Andalusia (Spain)

Introducción La candidemia es una infección nosocomial con elevada mortalidad. Los cambios clínicos y microbiológicos descritos en otras áreas y las novedades terapéuticas de los últimos años hacen preciso conocer si la epidemiología clínica de las candidemias en nuestro medio ha cambiado. Material y métodos Estudio prospectivo, multicéntrico y observacional de todos los episodios de candidemia en pacientes adultos atendidos entre el 1 octubre 2005 y el 30 septiembre 2006 en 17 hospitales de Andalucía. Resultados El número total de episodios fue de 220, la incidencia de 0,58 episodios/por cada 1.000 altas. Candida albicans fue la etiología más frecuente (53%). El 89% de las cepas fueron sensibles a fluconazol. La sepsis fue la presentación clínica más frecuente (65,7%). El tratamiento empírico fue inapropiado en el 38,7%. La mortalidad global (..) (AU)

Introduction: Candidemia is a nosocomial infection with high associated mortality. There have been changes in microbiology, epidemiology and treatment over the last few years, which has led us to analyse our own situation. Material and methods: Prospective, multicentre and observational study. All episodes of candidemia in adult patients seen in 17 Andalusian hospitals from 1 October 2005 to 30 September 2006 were included. Results: Were detected 220 cases, the incidence was 0.58 cases/1,000 hospital discharges. Candida albicans was the most frequent species (53% of cases). The majority of isolates (89%) was susceptibility to fluconazole. Sepsis was the most frequent clinical manifestation (65.7%). The treatment was inadequate in b38.7% of cases. Overall mortality was 40%.On univarite analysis (..) (AU)

[Candidemias: multicentre analysis in 16 hospitals in Andalusia (Spain)]. / Candidemias: análisis multicéntrico en 16 hospitales andaluces.

INTRODUCTION: Candidemia is a nosocomial infection with high associated mortality. There have been changes in microbiology, epidemiology and treatment over the last few years, which has led us to analyse our own situation. MATERIAL AND METHODS: Prospective, multicentre and observational study. All episodes of candidemia in adult patients seen in 17 Andalusian hospitals from 1 October 2005 to 30 September 2006 were included. RESULTS: Were detected 220 cases, the incidence was 0.58 cases/1,000 hospital discharges. Candida albicans was the most frecuent species (53% of cases). The majority of isolates (89%) was susceptibility to fluconazole. Sepsis was the most frequent clinical manifestation (65.7%). The treatment was inadequate in 38.7% of cases. Overall mortality was 40%. On univarite analysis death was found to be significantly associated with: aged > 60 years, unknown candidemia focus, Pitt score ≥ 2, APACHE II, shock at onset, persistents positive second blood cultures, non-removal of the central venous catheter and Candida species different of C. parasilopsis, among others. In the multivariate analysis death was found to be significantly associated with: aged > 60 years, Pitt score ≥ 2, Candida species different of C.parasilopsis and inadequate treatment. CONCLUSIONS: The candidemia clinical epidemiology in our region is similar to other areas and receiving inadequate treatment is the only modifiable risk factor associated with higher odds of mortality. Therefore, this modifiable factor needs to be improved to reduce the mortality.