Advertisement

Risk factors and epidemiology of Acinetobacter baumannii infections in a university hospital in Northern Italy: A case-control study

      Background

      Acinetobacter baumannii has emerged as a major cause of outbreaks of hospital-associated infections with increased morbidity and mortality among those affected.

      Methods

      We performed a 1:1 matched case-control study involving 68 cases in a teaching hospital in Northern Italy. Risk factors included general health conditions, comorbidities, diagnostic and therapeutic procedures, and antibiotic therapies. A multiple correspondence analysis (MCA) was performed to highlight possible association patterns among risk factors. After this, a conditional logistic regression model was applied.

      Results

      The combined results of the MCA and univariate regression models suggest that invasive procedures performed before intensive care unit admission, in particular bronchoscopy (odds ratio, 48.06) and oxygen therapy (odds ratio, 2.11), are associated with development of an infection. Malnutrition or obesity, lack of self-sufficiency, and severe liver diseases also proved to be significantly associated with infection. When analyzing antibiotic therapies, both the number of molecules administered and duration of therapy were significantly associated.

      Conclusions

      Early recognition of patients at high risk, environmental hygiene control measures, appropriate antibiotic prescriptions, especially regarding carbapenems, and high-quality training of health care workers in all hospital departments are all key aspects for prevention and control of Acinetobacter infection. Further studies are needed to investigate the role of antibiotics on microbial competition dynamics in relation to multidrug-resistant outbreaks.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Joly-Guillou M.L.
        Clinical impact and pathogenicity of Acinetobacter.
        Clin Microbiol Infect. 2005; 11: 868-873
        • Young L.S.
        • Sabel A.L.
        • Price C.S.
        Epidemiologic, clinical, and economic evaluation of an outbreak of clonal multidrug-resistant Acinetobacter baumannii infection in a surgical intensive care unit.
        Infect Control Hosp Epidemiol. 2007; 28: 1247-1254
        • Fournier P.E.
        The epidemiology and control of Acinetobacter baumannii in health care facilities.
        Clin Infect Dis. 2006; 42: 692-699
        • Katsaragakis S.
        • Markogiannakis H.
        • Samara E.
        • Pachylaki N.
        • Theodoraki E.M.
        • Xanthaki A.
        • et al.
        Predictors of mortality of Acinetobacter baumannii infections: a 2-year prospective study in a Greek surgical intensive care unit.
        Am J Infect Control. 2010; 38: 631-635
        • Burns K.
        • Foley M.
        • Donlon S.
        • Health Protection Surveillance Centre
        Point prevalence survey of hospital acquired infections & antimicrobial use in European acute care hospitals: May 2012—Republic of Ireland national report.
        2012 (Dublin, Ireland)
        • Agodi A.
        • Zarrilli R.
        • Barchitta M.
        • Anzaldi A.
        • Di Popolo A.
        • Mattaliano A.
        • et al.
        Alert surveillance of intensive care unit-acquired Acinetobacter infections in a Sicilian hospital.
        Clin Microbiol Infect. 2006; 12: 241-247
        • Hartzell J.D.
        • Kim A.S.
        • Kortepeter M.G.
        • Moran K.A.
        Acinetobacter pneumonia: a review.
        MedGenMed. 2007; 9: 4
        • Morgan D.J.
        • Rogawski E.
        • Thom K.A.
        • Johnson J.K.
        • Perencevich E.N.
        • Shardell M.
        • et al.
        Transfer of multidrug-resistant bacteria to healthcare workers' gloves and gowns after patient contact increases with environmental contamination.
        Crit Care Med. 2012; 40: 1045-1051
        • Valencia R.
        • Arroyo L.
        • Conde M.
        • Aldana J.M.
        • Torres M.J.
        • Fernández-Cuenca F.
        • et al.
        Nosocomial outbreak of infection with pan-drug-resistant Acinetobacter baumannii in a tertiary care university hospital.
        Infect Control Hosp Epidemiol. 2009; 30: 257-263
        • Maragakis L.L.
        • Perl T.M.
        Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options.
        Clin Infect Dis. 2008; 46: 1254-1263
        • Greenacre M.
        Correspondence analysis in medical research.
        Stat Methods Med Res. 1992; 1: 97-117
        • Husson F.
        • Lê S.
        • Pagès J.
        Exploratory multivariate analysis by example using R.
        CRC Press, Boca Raton, FL2011
        • Breslow N.E.
        • Day N.E.
        Statistical methods in cancer research. Volume I—the analysis of case-control studies.
        1980 (Lyon, France; IARC Scientific Publications No. 32)
        • Benz'ecri J.P.
        Sur le calcul des taux d'inertie dans l'analyse d'un questionnaire.
        Cah Anal Donnees. 1979; 4: 377-378