Epidemiologic characterization of nosocomial Acinetobacter baumannii infections in a Turkish university hospital by pulsed-field gel electrophoresis.
BACKGROUND
Although members of the Acinetobacter genus are not commonly part of the human flora, their relatively high prevalence in hospital environment frequently results in colonization of the skin and respiratory tract.


OBJECTIVE
The present investigation was carried out to elucidate epidemiologic characteristics of nosocomial Acinetobacter baumannii infections in a teaching hospital.


METHODS
Epidemiologic, clinical, and demographic features of the 66 patients with A baumannii infection during a 14-month period were recorded. Antibiotic susceptibilities of the isolates were determined by the standardized disk-diffusion method, and the clonal relationship of the isolates was analyzed by pulsed-field gel electrophoresis (PFGE).


RESULTS
The incidence of A baumannii infection was especially high in January, April, May, and June 2006. The isolates were most frequently obtained from blood and tracheal aspirates sent from the intensive care unit and neurosurgery ward. Although the most frequently identified predisposing factors were cerebrovascular disease and surgical operation, the main risk factors identified in these patients were catheterization and mechanical ventilation. Genotype analysis of the 66 A baumannii strains by PFGE revealed the circulation of 36 different PFGE types, of which type A (12) and K (17) accounted for 44% of the isolates. We found high clonal relationship (80.3%) among the typed strains. Thirteen antibiotypes were observed. Most of the isolates were multidrug resistant. Resistance to imipenem, meropenem, gentamicin, amikacin, tobramycin, netilmicin, ampicillin-sulbactam, trimethoprim-sulfamethoxazole, piperacillin-tazobactam, cefoperazone-sulbactam, ciprofloxacin, and levofloxacin were found in 44%, 47%, 47%, 84.8%, 21.2%, 3%, 62.1%, 57.6%, 94%, 62.1%, 95.5%, and 95.5% of the isolates, respectively.


CONCLUSIONS
The epidemiologic data obtained suggested that the increase in the number of A baumannii infections in our hospital was caused by the interhospital spread of especially 2 epidemic clones. We determined that clonally related strains can survive for a long time in our hospital and cause nosocomial infections in the predisposed patients.
Cetin
Emel Sesli
ES
Suleyman Demirel University Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Isparta, Turkey. seslicetin@med.sdu.edu.tr
Durmaz
Riza
R
Tetik
Tulay
T
Otlu
Bariş
B
Kaya
Selcuk
S
Calişkan
Ahmet
A
D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015373:Bacterial Typing Techniques; D002404:Catheterization / Q000009:adverse effects; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D005838:Genotype; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008826:Microbial Sensitivity Tests; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial