title: Clinical features and epidemiology of Acinetobacter baumannii colonization and infection in Spanish hospitals.
abstract: OBJECTIVE
  To investigate the clinical features and the epidemiology of Acinetobacter baumannii in Spanish hospitals.
  
  
  METHODS
  Prospective multicenter cohort study.
  
  
  METHODS
  Twenty-seven general hospitals and one paraplegic center in Spain.
  
  
  METHODS
  All cases of A. baumannii colonization or infection detected by clinical samples during November 2000 were included. Isolates were identified using phenotypic and genotypic methods. The molecular relatedness of the isolates was assessed by pulsed-field gel electrophoresis.
  
  
  RESULTS
  Twenty-five (89%) of the hospitals had 221 cases (pooled rate in general hospitals, 0.39 case per 1,000 patient-days; range, 0 to 1.17). The rate was highest in intensive care units (ICUs). Only 3 cases were pediatric. The mean age of the patients in the general hospitals was 63 years; 69% had a chronic underlying disease and 80% had previously received antimicrobial treatment. Fifty-three percent of the patients had an infection (respiratory tract, 51%; surgical site, 16%; and urinary tract, 11%). Crude mortality was higher in infected than in colonized patients (27% vs 10%; relative risk, 1.56; 95% confidence interval, 1.2 to 2.0; P = .003). Molecular analysis disclosed 79 different clones. In most hospitals, a predominant epidemic clone coexisted with other sporadic clones. Imipenem resistance was present in 39% of the hospitals.
  
  
  CONCLUSIONS
  A. baumannii was present in most participating Spanish hospitals (particularly in ICUs) with different rates among them. The organisms mainly affected predisposed patients; half of them were only colonized. Epidemic and sporadic clones coexisted in many centers.
authors.affiliation: Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
authors.forename: Jose M
authors.initials: JM
authors.lastname: Cisneros
authors.forename: Felipe
authors.initials: F
authors.lastname: Fernández-Cuenca
authors.forename: Anna
authors.initials: A
authors.lastname: Ribera
authors.forename: Jordi
authors.initials: J
authors.lastname: Vila
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez-Martínez
authors.forename: German
authors.initials: G
authors.lastname: Bou
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Pachón
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology*; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology*; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006769:Hospitals, General; D006782:Hospitals, Special; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology