title: [Prevalence of infection by carbapenem-resistant Acinetobacter baumannii in Spain (1999-2005)].
abstract: BACKGROUND
  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.
authors.affiliation: Servicio de Medicina Preventiva, Hospital Universitario Puerta de Hierro, Madrid, España. aasensio.hpth@salud.madrid.org
authors.forename: Angel
authors.initials: A
authors.lastname: Asensio
authors.forename: Rafael
authors.initials: R
authors.lastname: Cantón
authors.forename: Josep
authors.initials: J
authors.lastname: Vaqué
authors.forename: Francisco
authors.initials: F
authors.lastname: Calbo-Torrecillas
authors.forename: Rafael
authors.initials: R
authors.lastname: Herruzo
authors.forename: José Luis
authors.initials: JL
authors.lastname: Arribas
authors.forename: M Carmen
authors.initials: MC
authors.lastname: Sáenz
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000453:epidemiology*; D040981:Acinetobacter baumannii / Q000187:drug effects*; D000368:Aged; D000369:Aged, 80 and over; D015780:Carbapenems / Q000494:pharmacology* / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence
chemical_list: D015780:Carbapenems