title: Risk factors for nosocomial colonization with multiresistant Acinetobacter baumannii.
abstract: A six-month prospective survey was carried out in a university hospital to assess the incidence of Acinetobacter baumannii cross-contamination and to identify risk factors for colonization. Clinical isolates obtained during the study period were biotyped and genotyped by pulsed-field gel electrophoresis after ApaI macrorestriction of total DNA. Case-control univariate and multivariate analyses were performed to identify risk factors for Acinetobacter baumannii colonization. One hundred forty-seven patients hospitalized in 36 units were colonized or infected, of whom 52 were in three intensive care units. The urinary (29%) and bronchopulmonary tracts (26%) were the most frequently colonized sites. Nine major restriction patterns were identified: two were exhibited by epidemic multi-resistant strains of biotype 9 which were isolated from 65 patients hospitalized in ten units. Multivariate analysis showed that case-patients were (a) more likely than non-infected controls to be male, to have been previously hospitalized in another unit and to have had longer stays in the unit before colonization and hyperalimentation; and (b) more likely than controls colonized with other gram-negative bacilli to be male, to have had longer hospitalization, to have received treatment with third-generation cephalosporins and to have had a urinary catheter. The high incidence of colonization with Acinetobacter baumannii can thus be attributed to frequent cross-contamination and the use of broad-spectrum antibiotics. Colonized patients appear to be the major source of cross-contamination as epidemic strains spread throughout the hospital.
authors.affiliation: Laboratoire de Bactériologie-Hygiène, Faculté de Médecine, Hôpital Jean Minjoz, Besançon, France.
authors.forename: B
authors.initials: B
authors.lastname: Mulin
authors.forename: D
authors.initials: D
authors.lastname: Talon
authors.forename: J F
authors.initials: JF
authors.lastname: Viel
authors.forename: C
authors.initials: C
authors.lastname: Vincent
authors.forename: R
authors.initials: R
authors.lastname: Leprat
authors.forename: M
authors.initials: M
authors.lastname: Thouverez
authors.forename: Y
authors.initials: Y
authors.lastname: Michel-Briand
mesh_terms: D000151:Acinetobacter Infections / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors