title: Acinetobacter baumannii in critically ill patients: Molecular epidemiology, clinical features and predictors of mortality.
abstract: BACKGROUND
  The main aim of this study was to assess changes in the epidemiology and clinical presentation of Acinetobacter baumannii over a 10-year period, as well as risk factors of mortality in infected patients.
  
  
  METHODS
  Prospective, multicentre, hospital-based cohort studies including critically ill patients with A. baumannii isolated from any clinical sample were included. These were divided into a first period ("2000 study") (one month), and a second period ("2010 study") (two months). Molecular typing was performed by REP-PCR, PFGE and MSLT. The primary endpoint was 30-day mortality.
  
  
  RESULTS
  In 2000 and 2010, 103 and 108 patients were included, and the incidence of A. baumannii colonization/infection in the ICU decreased in 2010 (1.23 vs. 4.35 cases/1000 patient-days; p<0.0001). No differences were found in the colonization rates (44.3 vs. 38.6%) or infected patients (55.7 vs. 61.4%) in both periods. Overall, 30-day mortality was similar in both periods (29.1 vs. 27.8%). The rate of pneumonia increased from 46.2 in 2000 to 64.8% in 2010 (p<0.001). Performing MSLT, 18 different sequence types (ST) were identified (18 in 2000, 8 in 2010), but ST2 and ST79 were the predominant clones. ST2 isolates in the ICU increased from 53.4% in the year 2000 to 73.8% in 2010 (p=0.002). In patients with A. baumannii infection, the multivariate analysis identified appropriate antimicrobial therapy and ST79 clonal group as protective factors for mortality.
  
  
  CONCLUSIONS
  At 10 years of the first analysis, some variations have been observed in the epidemiology of A. baumannii in the ICU, with no changes in mortality. Epidemic ST79 clone seems to be associated with a better prognosis and adequate treatment is crucial in terms of survival.
authors.affiliation: Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Spain; Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Spain. Electronic address: jgarnachom@gmail.com.
authors.forename: José
authors.initials: J
authors.lastname: Garnacho-Montero
authors.affiliation: Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gutiérrez-Pizarraya
authors.affiliation: Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Spain; Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Díaz-Martín
authors.affiliation: Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Virgen del Rocío, Spain.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Cisneros-Herreros
authors.affiliation: Service of Microbiology, University Hospital Marqués de Valdecilla, Spain.
authors.forename: María Eugenia
authors.initials: ME
authors.lastname: Cano
authors.affiliation: Service of Microbiology, University Hospital Marqués de Valdecilla, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Gato
authors.affiliation: Service of Microbiology, University Hospital Marqués de Valdecilla, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ruiz de Alegría
authors.affiliation: Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen Macarena Hospital, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Fernández-Cuenca
authors.affiliation: Department of Clinical Microbiology, Hospital Clínic, Barcelona Centre for International Health Research, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vila
authors.affiliation: Service of Microbiology, University Hospital Marqués de Valdecilla, Spain; IDIVAL, Department of Molecular Biology, University of Cantabria, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez-Martínez
authors.affiliation: Microbiology Department, A Coruña University Hospital Complex, A Coruña, Spain.
authors.forename: M Del Mar
authors.initials: MD
authors.lastname: Tomás-Carmona
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI), Spain; Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen Macarena Hospital, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Pascual
authors.affiliation: Microbiology Department, A Coruña University Hospital Complex, A Coruña, Spain.
authors.forename: Germán
authors.initials: G
authors.lastname: Bou
authors.affiliation: Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Virgen del Rocío, Spain.
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Pachón-Diaz
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI), Spain; Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen Macarena Hospital, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000401:mortality; D040981:Acinetobacter baumannii / Q000235:genetics / Q000302:isolation & purification; D000328:Adult; D000368:Aged; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D013997:Time Factors
keywords: Acinetobacter baumannii; Clonalidad; Clonality; Enfermedades infecciosas; Infectious diseases; Intensive medicine; Medicina intensiva; Mortalidad; Mortality