Epidemiology of nosocomial colonization/infection caused by Acinetobacter spp. in patients of six surgical clinics in war and peacetime

Abstract

Background/Aim. Acinetobacter spp. has emerged as nosocomial pathogen during the past few decades in hospitals all over the world, but it has increasingly been implicated as a serious nosocomial pathogen in military hospitals. The aim of this study was to analyze and compare the surveillance data on Acinetobacter nosocomial colonization/infection (NCI) collected during the wartime with the data collected in peacetime. Methods. We conducted a prospective study of incidence of Acinetobacter spp. colonization/ infection. Also, the two nested case-control studies were conducted. The patients with nosocomial infection (cases) were compared with those with nosocomial colonization (controls) during the two different periods, wartime and peacetime. The patients with NCI by Acinetobacter spp. were identified by the case-based surveillance. The surveillance covered all the patients in 6 surgical clinics. Results. During the study periods a total of 166 patients had cultures that grew Acinetobacter spp. and the pooled rates of Acinetobacter spp. colonization and infection were significantly higher in wartime. When patients with NCI in wartime were compared with those with NCI in peacetime significant differences were observed. In the war year, the patients were more significantly males (p < 0.000). In a period of peace, most of the colonization/infections were reported from patients with certain chronic diseases (p = 0.020) and the survival of patients was more significant (p = 0.049). During the peacetime, proportions of Acinetobacter isolates resistent to ciprofloksacin, imipenem and meropenem were significantly higher (p < 0.001). Conclusion. This study provides additional important information about the risk factors of nosocomial Acinetobacter spp. infections in a large cohort of surgical patients. This is also the first study that directly examines epidemiological differences between NCI caused by Acinetobacter spp. during the war and peace period.Uvod/Cilj. U poslednjih par decenija Acinetobacter spp. postaje znacajan uzrocnik kolonizacija/infekcija kod hospitalizovanih bolesnika. Njegovo sirenje dobilo je poseban znacaj u vojnim bolnicama. Cilj ovog istrazivanja bio je da se uporede rezultati epidemioloskog nadzora nad bolnickim kolonizacijama/infekcijama uzrokovanim ovom bakterijom dobijeni u periodu rata sa rezultatima dobijenim u periodu mira. Metode. Istrazivanje je radjeno kao prospektivna studija incidencije kolonizovanih/inficiranih bolesnika Acinetobacter spp. Takodje, izvedene su dve ?ugnezdjene? anamnesticke studije. Bolesnici sa infekcijom uzrokovanom Acinetobacter spp. (slucajevi) uporedjeni su sa kolonizovanim bolesnicima (kontrole) istim uzrocnikom u periodu rata i u periodu mira. Sveobuhvatni epidemioloski nadzor u cilju identifikacije ispitanika sproveden je u sest hirurskih klinika Vojnomedicinske akademije. Rezultati. U periodu istrazivanja registrovano je 166 bolesnika kod kojih je izolovan Acinetobacter spp. kao uzrocnik kolonizacije ili infekcije. Uoceno je da su stopa kolonizacije/infekcije na svim posmatranim klinikama bile znacajno vise u periodu rata. Takodje, postojale su znacajne razlike izmedju ispitanika u periodu rata u odnosu na period mira. U ratnoj godini, ispitanici su cesce bili muskog pola (p < 0,000), dok su u godinama mira ispitanici cesce bolovali od neke hronicne bolesti (p = 0,020), a i prezivljavanje ispitanika bilo je znacajno ucestalije (p = 0,049). Rezistencija izolata Acinetobacter spp. na ciprofloksacin, imipenem i meropenem bila je znacajno ucestalija u periodu mira (p < 0,001). Zakljucak. Ovo istrazivanje obezbedjuje dodatne informacije o faktorima rizika od nastanka infekcija izazvanih Acinetobacter u kohorti hirurskih bolesnika. Takodje, ovo istrazivanje po prvi put ukazuje na znacajne epidemioloske razlike izmedju kolonizovanih/inficiranih bolesnika u periodu mira u odnosu na ratni period.