Abstract
Recent studies report seasonality in healthcare-associated infections, especially those caused by Acinetobacter baumannii complex. We conducted an ecologic study aimed at analyzing the impact of seasons, weather parameters and climate control on the incidence and carbapenem-resistance in A. baumannii complex bloodstream infections (ABBSI) in hospitals from regions with different climates in Brazil. We studied monthly incidence rates (years 2006-2015) of ABBSI from hospitals in cities from different macro-regions in Brazil: Fortaleza (Ceará State, Northeast region), Goiânia (Goiás State, Middle-west) and Botucatu (São Paulo State, Southeast). Box-Jenkins models were fitted to assess seasonality, and the impact of weather parameters was analyzed in Poisson Regression models. Separate analyses were performed for carbapenem-resistant versus carbapenem-susceptible isolates, as well as for infections occurring in climate-controlled intensive care units (ICUs) versus non-climate-controlled wards. Seasonality was identified for ABSSI ICUs in the Hospitals from Botucatu and Goiânia. In the Botucatu hospital, where there was overall seasonality for both resistance groups, as well as for wards without climate control. In that hospital, the overall incidence was associated with higher temperature (incidence rate ratio for each Celsius degree, 1.05; 95% Confidence Interval, 1.01-1.09; P = 0.006). Weather parameters were not associated with ABBSI in the hospitals from Goiânia and Fortaleza. In conclusion, seasonality was found in the hospitals with higher ABBSI incidence and located in regions with greater thermal amplitude. Strict temperature control may be a tool for prevention of A. baumanii infections in healthcare settings.
Highlights
Despite their specific characteristics, healthcare-associated infections (HCAIs) can share some epidemiological determinants with those that occur in the community
Seasonality, increasingly identified in recent studies, is one example [1]. It is prominent in bloodstream infections caused by Gram-negative bacilli (GNB), which have been linked to proximity to the equator [2], summer season [3] and high environmental temperatures measured either within [4] or outside hospitals [5]
Seasonality was identified for ABSSI in intensive care units (ICUs) in the Hospitals from Botucatu and Goiania
Summary
Healthcare-associated infections (HCAIs) can share some epidemiological determinants with those that occur in the community. Seasonality, increasingly identified in recent studies, is one example [1] It is prominent in bloodstream infections caused by Gram-negative bacilli (GNB), which have been linked to proximity to the equator [2], summer season [3] and high environmental temperatures measured either within [4] or outside hospitals [5]. This latter aspect is one of the gaps in our current understanding of HCAIs seasonality, since GNB incidence increases during warm periods even within units that are climate-controlled (and expected not to present relevant temperature variations) [1,5,6,7]. Those findings were not supported by other studies, especially those pointing to relevant “summer peaks” of multidrug-resistant GNB infections [6,7,10]
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