[Prevalence of infection by carbapenem-resistant Acinetobacter baumannii in Spain (1999-2005)]. / Prevalencia de infecciones por Acinetobacter baumannii resistente a carbapenemas en España (1999-2005).

INTRODUCTION: This study determines the prevalence of infections by carbapenem-resistant Acinetobacter baumannii (CRAB) in Spain, and identifies trends over time, geographical variations, and factors associated with resistance. METHODS: Yearly prevalence surveys (EPINE, Estudio de Prevalencia de las Infecciones Nosocomiales en España) during 1999 to 2005 were analyzed, including data on the site of infection, culture, and antimicrobial susceptibility, and characteristics of the patients and hospitals. RESULTS: On average, 246 hospitals/year participated in the survey. A total of 1168 A. baumannii isolates were identified, yielding an infection prevalence rate of 3/1,000 hospitalized patients. Fourteen percent of isolates were related to community-onset infections. The most frequent sites of infection were the respiratory tract (42.2%), surgical wound (15.1%), urinary tract (12.9%), and skin (11.7%). Rate of carbapenem resistance was 34.5% (95% CI, 31.8-37.3), and was even higher among ICU patients (43.8%; 95% CI, 38.9%-48.7%). There were considerable differences between Spanish regions, with the highest rates of resistance in central regions. Higher resistance rates were observed in respiratory tract infections (43%) and catheter-related bacteremia (47.6%) than among other sites of infection (P =.003). Main factors associated with CRAB identified by multivariate analysis were surgical or tracheostomy procedures, use of invasive devices such as urinary, nasogastric, or central venous catheters, and mechanical ventilation, as well as male gender and pressure sores. CONCLUSIONS: The prevalence of CRAB in Spain is very high. Differences in resistance rates have been observed according to geographic region and area of hospitalization. Several invasive procedures, as well as male gender and pressure sores, are associated with higher rates of carbapenem resistance.

Prevalencia de infecciones por Acinetobacter baumannii resistente a carbapenemas en España (1999-2005) / Prevalence of Infection by Carbapenem-resistant Acinetobacter baumannii in Spain (1999-2005)

Introducción. Los objetivos de este estudio son determinar la prevalencia de las infecciones por Acinetobacter baumannii resistente a carbapenemas (ABRC) en España, su tendencia, diferencias geográficas, e identificar factores asociados a su resistencia. Métodos. Se analizaron las encuestas anuales del estudio de prevalencia EPINE (1999-2005), incluyendo la localización de la infección, los cultivos y sus resistencias antibióticas, y las características de los pacientes y de los hospitales. Resultados. Participaron 246 hospitales/año. Se identificaron 1.168 aislamientos de A. baumannii (tasa de prevalencia de infecciones por A. baumannii de 3/1.000). El 14% correspondieron a infecciones de inicio en la comunidad. La tasa de resistencia a carbapenemas fue del 34,5% (intervalo de confianza del IC95% [IC 95%]: 31,8-37,3) y del 43,8% (IC 95%: 38,9-48,7) en unidad de cuidados intensivos. Se observó una mayor resistencia en las comunidades autónomas de la zona centro. Las infecciones respiratorias (43%) y las bacteriemias asociadas a dispositivo (47,6%) se asociaron a una mayor tasa de resistencia (p 5 0,003). Los principales factores asociados a ABRC son los procedimientos quirúrgicos o de traqueotomía, la utilización de dispositivos invasivos, tales como la sonda urinaria o nasogástrica, los catéteres venosos centrales y la ventilación mecánica, así como el sexo varón y la presencia de úlceras por presión. Conclusiones. La prevalencia de ABRC es muy elevada y se encuentran diferencias por zonas geográficas, y por áreas de hospitalización. Determinados procedimientos invasivos, así como el sexo varón y las úlceras por presión, se encuentran asociados a una mayor tasa de resistencia carbapenemas (AU)

Introduction. This study determines the prevalence of infections by carbapenem-resistant Acinetobacter baumannii (CRAB) in Spain, and identifies trends over time, geographical variations, and factors associated with resistance. Methods. Yearly prevalence surveys (EPINE, Estudio de Prevalencia de las Infecciones Nosocomiales en España) during 1999 to 2005 were analyzed, including data on the site of infection, culture, and antimicrobial susceptibility, and characteristics of the patients and hospitals. Results. On average, 246 hospitals/year participated in the survey. A total of 1168 A. baumannii isolates were identified, yielding an infection prevalence rate of 3/1,000 hospitalized patients. Fourteen percent of isolates were related to community-onset infections. The most frequent sites of infection were the respiratory tract (42.2%), surgical wound (15.1%), urinary tract (12.9%), and skin (11.7%). Rate of carbapenem resistance was 34.5% (95% CI, 31.8-37.3), and was even higher among ICU patients (43.8%; 95% CI, 38.9%-48.7%). There were considerable differences between Spanish regions, with the highest rates of resistance in central regions. Higher resistance rates were observed in respiratory tract infections (43%) and catheter-related bacteremia (47.6%) than among other sites of infection (P 5.003). Main factors associated with CRAB identified by multivariate analysis were surgical or tracheostomy procedures, use of invasive devices such as urinary, nasogastric, or central venous catheters, and mechanical ventilation, as well as male gender and pressure sores. Conclusions. The prevalence of CRAB in Spain is very high. Differences in resistance rates have been observed according to geographic region and area of hospitalization. Several invasive procedures, as well as male gender and pressure sores, are associated with higher rates of carbapenem resistance (AU)