Previous Article in Journal
Regional Cerebral Oxygen Saturation and Risk of Delirium: A Systematic Review and Meta-Analysis
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Diseases
Volume 13
Issue 12
10.3390/diseases13120384
diseases-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Hospital-Acquired Infections Caused by Acinetobacter baumannii: A Comparative Analysis of Risk Factors with Other ESKAPE-E Pathogens in a Third-Level IMSS Hospital in Yucatan Mexico

by
Jael del Rosario Eb-Rejón
1,
José Ramón Paniagua-Sierra
2,
Carlos Gracida-Osorno
3 and
Gloria María Molina-Salinas
4,*
1
División de Epidemiología, Hospital de Especialidades, CMN Ignacio García Téllez, Instituto Mexicano del Seguro Social, Mérida 97150, Yucatán, Mexico
2
Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico
3
Servicio de Medicina Interna, Hospital General Regional No. 1, CMN Ignacio García Téllez, Instituto Mexicano del Seguro Social, Mérida 97150, Yucatán, Mexico
4
Unidad de Investigación Médica Yucatán, Hospital de Especialidades, CMN Ignacio García Téllez, Instituto Mexicano del Seguro Social, Mérida 97150, Yucatán, Mexico
*
Author to whom correspondence should be addressed.
Diseases 2025, 13(12), 384; https://doi.org/10.3390/diseases13120384
Submission received: 28 October 2025 / Revised: 19 November 2025 / Accepted: 25 November 2025 / Published: 26 November 2025
(This article belongs to the Section Infectious Disease)
Browse Figures
Versions Notes

Abstract

Background: Acinetobacter baumannii is classified within the ESKAPE-E group of pathogens, recognized for its role in causing severe infections, and is often associated with various healthcare-related infection (HAIs) types, particularly in intensive care units. This opportunistic pathogen is distinguished by its considerable antibiotic resistance and is associated with prolonged hospital stays, high medical costs, and increased mortality rates. Objective: This study investigated factors associated with HAIs caused by A. baumannii, versus other ESKAPE-E pathogens, to identify distinguishing intrinsic and extrinsic factors that guide the control and prevention of HAIs within our hospital. Methods: This study included patients from a Third-Level IMSS Hospital in Mérida, Mexico, between 2018 and 2022, with 54 cases (HAIs caused by A. baumannii) and 108 matched controls (HAIs caused by other ESKAPE-E pathogens). Results: Ventilator-associated pneumonia was the most frequent HAI in both groups, followed by catheter-related bloodstream infections. Comorbidities were more common in patients with HAIs caused by A. baumannii than in those with other ESKAPE-E pathogens. Most patients received antimicrobial treatment before HAIs development. Bivariate analysis showed that comorbidities and prior meropenem and linezolid treatment were significant risk factors, whereas multivariate analysis identified comorbidities and prior meropenem use as risk factors for A. baumannii HAIs versus other ESKAPE-E pathogens. Most A. baumannii isolates were extensively drug-resistant (90.7%), with 84% showing carbapenem resistance. Conclusions: This study highlights the importance of optimizing antimicrobial use and measures to mitigate A. baumannii HAIs. These findings have significant implications for infection control and antimicrobial stewardship in healthcare settings.

1. Introduction

Healthcare-associated infections (HAIs) are infections or toxin-related conditions that are absent upon admission but may emerge 48 h or more after hospital admission, or within 30 days of treatment. HAIs are the most prevalent adverse outcomes in the provision of healthcare services [1]. In 2023, a comprehensive systematic review of 400 studies conducted globally estimated the overall prevalence of HAIs to be 14% [2]. The World Health Organization (WHO) report on the global impact of HAIs indicates that infection rates range from 3.6% to 12% in high-income countries and from 5.4% to 19.1% in low- and middle-income countries [3]. A recent analysis by the Organization for Economic Co-operation and Development (OECD) and WHO projects that up to 3.5 million individuals worldwide could succumb to HAIs annually by 2050 [4].
Causal agents of HAIs include fungi, viruses, parasites, and bacteria [5], notably the ESKAPE-E bacteria, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp., and Escherichia coli, which are a major cause of HAIs globally and exhibit high rates of antimicrobial resistance (AMR) [6,7]. The WHO has categorized drug-resistant ESKAPE-E pathogens as critical, high-, and medium-priority pathogens, showing their substantial threat to human health, and the need for urgent research, development, and public health interventions [8,9]. Among this group, the critical priority pathogen A. baumannii is an opportunistic bacterium that infects critically ill patients and has emerged as a global health concern owing to its ability to survive in harsh environments such as medical equipment, contributing to the spread of multidrug-resistant (MDR) clones in hospitals. The management of A. baumannii HAIs is significantly complicated by this issue, leading to prolonged hospitalizations, and a high prevalence of drug resistance, often to carbapenems, which are regarded as last-resort antibiotics. Drug resistance of A. baumannii is associated with higher mortality rates [10,11].
In Mexico, HAIs caused by A. baumannii have emerged as a significant concern because of the high drug resistance rate of this bacterium to multiple antibiotics and its association with hospital outbreaks [12,13,14]. Single-center and multicenter investigations have reported drug resistance rates exceeding 50% for conventional antibiotics and 69–90% for carbapenems against A. baumannii, which are higher than the global averages [15,16,17,18]. In Yucatan, Mexico, our research group documented an increase in antibiotic resistance rates for A. baumannii in patients from the intensive care unit (ICU), highlighting carbapenem resistance, which increased from 56.6% (2016–2018) to 95.5% (2019–2021) [19,20].
Although investigations have explored the risk factors for A. baumannii infections across diverse patient populations [21,22,23], there is a paucity of studies focusing on the potential differences in risk factors between HAIs caused by A. baumannii and those caused by other ESKAPE-E priority pathogens. This study hypothesized that both intrinsic and extrinsic epidemiological and clinical factors contribute to the risk of acquired HAIs caused by A. baumannii in contrast to other ESKAPE-E bacteria. Consequently, this study aimed to investigate the factors associated with HAIs caused by A. baumannii, as opposed to the HAIs caused by other ESKAPE-E pathogens, in patients attending a Tertiary-Care Hospital in Merida, Yucatán, Mexico, and to identify distinguishing intrinsic and extrinsic factors that guide the control and prevention of HAIs within our hospital.

2. Materials and Methods

2.1. Study Type and Design

This study employed a retrospective case–control design conducted at the Instituto Mexicano del Seguro Social (IMSS) Yucatán Tertiary-Care Hospital, which includes 175 beds, spanning the period from 1 January 2018 to 31 December 2022. HAIs caused by ESKAPE-E pathogens were identified using clinical and microbiological criteria. The case group consisted of patients who developed some type of HAIs caused by A. baumannii, while the control group included patients who acquired some type of HAIs of bacterial etiology from the ESKAPE-E group, excluding A. baumannii, during their hospitalization. The selection criteria are listed in Table 1. The matching criteria for cases and controls were set at a 1:2 ratio, ensuring that each case and its corresponding control were matched by the same type of HAIs, sex, and similar age group.

2.2. Sample and Sampling Methodology

The sample size was determined using Epi Info 7.2 for Windows statistical software, specifically using the StatCalc function. The calculation resulted in 54 cases and 108 controls to maintain a 1:2 case–control ratio. A non-probabilistic sequential sampling technique was used.

2.3. Data Collection

Information was collected through a review of the Nosocomial Infections Registration System (INOSO, IMSS) and patient medical records without direct participant contact or intervention. Information about demographic, clinical, and microbiological data was extracted from medical and laboratory records.

2.4. Statistical Analysis

Data processing and tabulation were performed using Microsoft Excel, and statistical analyses were performed using SPSS version 25.0 (IBM, New York, USA). A comprehensive descriptive analysis was conducted for all the study variables. Qualitative variables were expressed as frequencies and percentages, and quantitative variables were expressed as means and standard deviations. Data were assessed using the Kolmogorov–Smirnov test. Student’s t-test was used for continuous variables, and the Mann–Whitney U test was used for non-normally distributed variables. Categorical variables were analyzed using the chi-squared and Fisher’s exact tests. The association between variables was measured using odds ratios (OR) with 95% confidence intervals (CI) of the variables, with statistical significance established at significance set at p < 0.05.

3. Results

3.1. HAIs Caused by ESKAPE-E

During the five-year study period, 1892 HAIs were documented. Among them, 101 cases of A. baumannii HAIs were identified, resulting in an overall prevalence of 5.3%. In contrast, 1094 HAIs were attributed to the rest of the ESKAPE-E pathogens, with a prevalence of 57.8%, and infection caused by E. coli was the most common (30.8%). No HAIs caused by Enterobacter spp. were identified during the study period (Figure 1).
The annual prevalence of A. baumannii HAIs fluctuated from 2018 to 2022. The prevalence peaked in 2021 at 8.8% before decreasing to 4.9% in 2022, marking the highest value for the study period. A notable decrease was observed in 2020, which may be attributable to the initial wave of the COVID-19 pandemic. The most concerning aspect was the tripling of A. baumannii HAIs prevalence during the study period (2021 vs. 2022). A similar trend was observed for other ESKAPE-E bacterial HAIs, with higher prevalence rates in 2021 and similar rates in 2018, 2020, and 2022 (Figure 2).

3.2. Sociodemographic and Clinical Characteristics of Case and Control Groups and Univariate Analysis

Following the description of the distribution and prevalence of HAIs caused by A. baumannii in comparison to other ESKAPE-E pathogens, the sociodemographic and clinical characteristics of patients with HAIs caused by A. baumannii (cases) and those with HAIs due to other ESKAPE-E pathogens (controls) were examined. This analysis aimed to identify the risk factors associated with A. baumannii infection.
Table 2 delineates the sociodemographic and clinical characteristics of the case and control groups concerning HAIs. Considering that this was a matched case–control study based on age and HAIs type, it is noteworthy that the control group consisted of slightly younger participants. Both groups showed a notable prevalence of hypertension, diabetes mellitus, and oncohaematological diseases as comorbidities. The invasive procedure was more common, without statistical differences in patients with A. baumannii HAIs prior to mechanical ventilation (75.9% vs. 58.3%, p = 0.37) and exhibited prolonged hospital stays (40.2 vs. 36.9 days, p = 0.122) compared to the control group, whereas the average number of days in the ICU was almost the same for both groups (21.4 vs. 22.4 days, p = 0.196). Most patients in both groups were discharged from the hospital (57.4% vs. 60.2%, p = 0.360). HAIs caused by A. baumannii were associated with a mortality rate of 37.0%, which was slightly higher than the 28.7% mortality rate associated with HAIs caused by other ESKAPE-E microbes.
In accordance with Magiorakos et al. (2012) [24], we found that a substantial proportion of A. baumannii clinical isolates were classified as extensively drug-resistant (XDR; 90.7%), with 84% of them demonstrating carbapenem resistance. The most prevalent bacteria in the control group were E. coli (28.8%), P. aeruginosa (25.9%), and K. pneumoniae (24.0%). The MDR profiles ranged from 3.7% to 15.8%, and XDR profiles ranged from 2.8% to 24.1%, with higher prevalence observed in E. coli (24.1%) and K. pneumoniae (20.3%) [24]. In addition, the prior administration of fluoroquinolones, carbapenems, and third-generation cephalosporins was frequently observed before the onset of HAIs caused by A. baumannii. Conversely, the use of third-generation cephalosporins, fluoroquinolones, and aminoglycosides was more common in HAIs caused by other ESKAPE-E pathogens. In the case group, the prescription of three antibiotics was the most common (31.5%), while in the control group, one antibiotic was prescribed (47.3%).
Furthermore, univariate analysis identified statistically significant differences between the groups in terms of comorbidities, duration of invasive procedures, and prior antibiotic therapy with fluoroquinolones, carbapenems, and oxazolidinones.

3.3. Risk Factors Associated with HAIs Caused by A. baumannii vs. Other ESKAPE-E Pathogens

Table 2 summarizes the patients characteristics and risk factors associated with HAIs caused by A. baumannii compared to those caused by other ESKAPE-E pathogens. Bivariate analysis suggested an association with comorbidities and prior treatment with levofloxacin (LEV), meropenem (MEM), and linezolid (LZD). Given the potential influence of confounders, a conditional logistic regression was performed to adjunt for covariates such as age, sex, comorbidities, and invasive procedures. This adjustment allowed for the identification of independent predictors. The multivariable model confirmed that comorbidities and MEM use were significantly associated with A. baumannii HAIs, indicating that these variables exert an independent effect beyond overlapping clinical conditions or treatment exposures.

4. Discussion

The findings confirmed that intrinsic factors, such as comorbidities, and extrinsic factors, such as the duration of invasive devices and prior antimicrobial treatment, increase the risk of A. baumannii HAIs.

4.1. Sociodemographic and Clinical Characteristics

The median age of the patients was 41 years and that of the controls was 46 years, which differs from studies reporting median ages of 59 and 60 years. This discrepancy likely stems from the inclusion of patients from various departments, not only the ICU [25,26]. The mean age was 39.26 years (SD ± 26.6) for cases and 39.8 years (SD ± 26.8) for controls, contrasting with studies reporting means of 55.13 years (SD ± 18.44) for cases and 58.47 years (SD ± 19.77) for controls [27], as those focused on adults and specific HAIs. Furthermore, most patients in each group were predominantly within the age ranges of 27–59 years (38.9% vs. 37%, p = NS) and ≥60 years (31.5% vs. 29.6%, p = NS). Both groups showed higher male predominance than female predominance (83.3 vs. 16.7%, p = NS), consistent with Huertas Vaquero et al. (2021) [26], who reported high prevalence of male cases (65% cases involving HAIs caused by A. baumannii) compared to controls (53.4% without infection), in contrast to female cases (35% cases) compared to controls (46.6%), which were derived from matching based on HAIs type and sex, in contrast to previous studies [28]. Factors influencing sex-based infection outcomes include the quality of medical care, sex hormones, immune responses from sex-related polymorphisms, and chronic comorbidities [28]. Further research is needed to investigate these sex differences in HAIs caused by ESKAPE-E including the enhancement of pro-inflammatory cytokines by estradiol [29]. Monitoring blood glucose levels is essential because hyperglycemia increases the risk of mortality, complications, and HAIs [30]. Infections caused by A. baumannii are more prevalent in patients with preexisting health conditions or chronic illnesses [31,32]. In our study, 88.9% of the case group presented with at least one health issue upon admission, in contrast to 72.2% of the control group. Ardoino et al. (2016) [21] found trauma, ulcers, malnutrition, and liver diseases to be common health issues in patients with HAIs caused by A. baumannii. However, our findings showed that hypertension, diabetes, hematological malignancies, and low body weight were the most prevalent conditions. The first three conditions were observed in both groups. This discrepancy is likely attributable to our hospital’s specialization in oncology and the higher prevalence of chronic diseases in our country compared to Europe. Malnutrition affects 25–50% of hospitalized patients and often worsens during hospitalization. Given the link between nutrition, infection, and immunity, future research should examine the nutritional status of patients with hospital-acquired infections [33,34].
Among the 54 patients (cases), 36 acquired HAIs due to A. baumannii during their ICU stay. Conversely, 68 of the 108 controls developed HAIs attributable to other ESKAPE-E bacteria in the ICU (62.9 vs. 66.7%). These findings underscore the high infection rates in the ICU and the challenges in managing critically ill patients who require invasive devices. For A. baumannii HAIs, our results for ventilator-associated pneumonia (VAP) at 50% and catheter-related bloodstream infections (CRBSI) at 29.6% are consistent with national data, which report VAP and central line-associated bloodstream infection rates of 57.9% and 16.8%, respectively [35]. In the United States, HAIs caused by A. baumannii account for 6% of VAP cases and 2% of CRBSI cases [36]. The analysis of invasive device use in our study indicated that the case group had the highest incidence of interventional medical procedures, with the central venous catheter (CVC) being the most frequently used device, employed in 98.1% of cases and 89.8% of controls. This finding contrasts with the results reported by Gu et al. (2021) [27], who identified tracheal intubation as the most common procedure among cases (48.9%) and controls (50.0%), and by Ardonio et al. (2016) [21], who documented endoscopy as the predominant invasive procedure in their case group (77.9%) and controls (25.0%). CVCs are often used in patients from highly specialized hospitals, such as those in our study, who are undergoing treatment for severe conditions and require a patent central line for antibiotic administration and fluid therapy.
According to Playford et al. (2007) [25], 52% of patients had HAIs caused by carbapenem-resistant A. baumannii. The primary infections were VAP, bloodstream infection, and surgical site infection, with 19, 7, and 4 reported cases, respectively. The drug resistance profiles of A. baumannii in our study were consistent with those reported in international and national studies. The frequency of MDR (35.4%) and extensively drug-resistant (XDR, 7.1%) profiles among isolates in Central America [37]. In South Africa [38], the ranges of MDR, XDR and pan-resistant (PDR) were 53–60% for MDR, 1–19% for XDR, and 1% for PDR, respectively. The National Institute of Cancerology of Mexico City reported 24% MDR A. baumannii in blood cultures [39], whereas Christus Muguerza Hospital in Monterrey, Mexico reported 64% XDR A. baumannii in ICU patients [40]. In our study, XDR A. baumannii was identified as the most prevalent resistance profile, accounting for 90.7% of cases, while the remaining 9.3% were classified as MDR. AMR has emerged as a significant phenomenon that increases global healthcare costs. Despite the development of new antimicrobial agents, AMR continues to increase [41]. The GEIH-REIPI-Ab 2010 project in Spain reported A. baumannii drug resistance rates exceeding 94% for ceftazidime, piperacillin, and ciprofloxacin; 82–86% for carbapenems and tetracycline; and 60–70% for tobramycin, sulbactam, gentamicin, and doxycycline. The drug resistance rates were 49%, 30%, 24%, and 3% for amikacin, minocycline, tigecycline, and colistin, respectively [42]. Previous AMR reports from our hospital’s ICU showed resistance to third- and fourth-generation cephalosporins (81.13–67.92%), ciprofloxacin (79.25%), gentamicin (84.91%), and trimethoprim/sulfamethoxazole (77.36%) [19]. Our research showed that AMR increased over five years, with resistance to ceftazidime and ciprofloxacin rising from 83% to 100%, cefepime and trimethoprim/sulfamethoxazole from 79% to 100%, gentamicin from 64% to 100%, and carbapenems from 33% to 74%. The efficacy of carbapenems has been increasingly undermined by resistance mechanisms [36,43]. This increase in AMR limits therapeutic options and facilitates the spread of drug-resistant pathogens, which is attributed to the selective pressure from inappropriate antimicrobial use [44,45].
Regarding the administration of antibiotics prior to any type of HAIs, Huertas-Vaquero et al. (2021) [26] reported that all patients had received prior antibiotic therapy, in contrast to only one in three control patients. The antibiotics used in both groups included ceftazidime, ceftriaxone, amoxicillin/clavulanate, imipenem, LEV, LZD, and vancomycin [17]. Gu et al. (2021) [27] observed a significantly higher frequency of prior carbapenem use in their case group (83.0%) compared to the controls (26.6%). In our study population, 100% of patients in the case group received antibiotic therapy prior to HAIs, with the most frequently prescribed antibiotics being MEM (15.3%), LEV (12.5%), and vancomycin (9.7%). In contrast, 91.6% of the control patients had received prior antibiotic therapy, predominantly cefotaxime (14.4%), LEV (12.3%), and amikacin (10.7%).
Evaluating the clinical impact of A. baumannii on mortality is challenging because of its tendency to infect critically ill patients who often experience adverse outcomes regardless of infection. Mortality rates associated with A. baumannii range from 26% to 68%, although directly attributing deaths continue problematic [25]. We observed higher mortality in cases than in controls (37.0% vs. 28.7%). Gu et al. (2021) [27] reported 34.0% mortality in patients with HAIs from A. baumannii, compared to 21.0% for other site infections. Ren et al. (2019) [46] identified 19.4% mortality in patients with hospital-acquired pneumonia due to MDR A. baumannii versus 6.1% in those with susceptible A. baumannii.

4.2. Risk Factors

Analysis of the groups revealed statistically significant differences in comorbidities, duration of invasive procedures, and prior antibiotic treatments with fluoroquinolones, carbapenems, and oxazolidinones (Table 2). The initial bivariate analysis revealed significant associations for some variables, such as comorbidities (OR 3.07, 95% CI 1.19–7.93, p = 0.016), and prior use of one-by-one antibiotics was identified as a risk factor for MEM (OR 7.56, 95% CI 3.16–18.08, p < 0.0001) and LZD (OR 6.53, 95% CI 2.19–19.49, p < 0.0001). Subsequent multivariate analysis revealed that: (1) comorbidities increased the probability three-fold of acquiring any type of HAI by A. baumannii compared to other ESKAPE-E microbes, and (2) prior use of MEM increased the likelihood of acquiring HAIs by A. baumannii 5.47-fold (2.12–14.07 CI, p < 0.0001). These findings align with those of prior studies, such as that by Huertas Vaquero et al. (2021) [26], which identified previous carbapenem use as having an OR of 4.26 (95% CI, 2.52–5.90, p= 0.001) and quinolones with an OR of 3.15 (95% CI 1.20–5.10, p = 0.002) as risk factors for A. baumannii infection and/or colonization. Ardonio et al. (2016) [21] also supported this by demonstrating that carbapenem use (OR 11, 95% CI 1.42–85.19, p = 0.021) was linked to the onset of A. baumannii infection. It is essential to examine antibiotic usage, especially regarding duration and dosage, in the context of A. baumannii, which arises from the pressure of broad-spectrum antibiotics and transmission of strains among patients, healthcare staff, and hospital settings [47,48]. In our Tertiary-Care Hospital, patients often need extended stays and prolonged use of invasive devices. If these devices are not correctly installed and maintained, there is an increased risk of infection by complex bacteria such as A. baumannii.

5. Conclusions

Our findings indicate that the presence of comorbidities, the number of days of utilization of invasive devices, and prior prescription of carbapenems predispose patients (cases) to developing HAIs caused by A. baumannii, in contrast to patients (controls) with the same type of HAIs caused by other members of the ESKAPE-E pathogens. Early identification of risk factors, such as comorbidities that predispose individuals to infection by A. baumannii rather than other ESKAPE-E bacteria, is essential. The appropriate use and maintenance of medical devices, along with the judicious use of antibiotics, particularly MEM, are critical for mitigating and managing the escalation of AMR. Enhanced regulatory measures governing antibiotic prescriptions are essential to reduce unnecessary usage. This is particularly important for carbapenems, which should be reserved for use as a last resort. Therefore, it is imperative to strengthen antibiotic stewardship programs.

Author Contributions

Conceptualization, J.d.R.E.-R. and G.M.M.-S.; methodology, J.d.R.E.-R., J.R.P.-S. and G.M.M.-S.; validation, J.d.R.E.-R., J.R.P.-S., C.G.-O. and G.M.M.-S.; formal analysis, J.d.R.E.-R., J.R.P.-S., C.G.-O. and G.M.M.-S.; investigation, J.d.R.E.-R., J.R.P.-S., C.G.-O. and G.M.M.-S.; data curation, J.d.R.E.-R.; writing—original draft preparation, G.M.M.-S.; writing—review and editing, J.d.R.E.-R., J.R.P.-S., C.G.-O. and G.M.M.-S.; supervision, J.R.P.-S. and G.M.M.-S. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Local Scientific, Biosafety, and Ethics Committees of Instituto Mexicano del Seguro Social (IMSS) Yucatán Tertiary-Care Hospital with protocol number approved R-2022-3203-001 (approval date: 18 February 2022).

Informed Consent Statement

Not applicable.

Data Availability Statement

The original contributions of this study are comprehensively detailed within the article. For further inquiries, please contact the corresponding author.

Acknowledgments

This research did not receive any specific grants from funding agencies in the public, commercial, or non-profit sectors. JRER expresses gratitude to the Instituto Mexicano del Seguro Social for awarding her a scholarship to pursue a Master’s Degree in the Postgraduate Program of Medical, Odonatological, and Health Sciences at the Universidad Nacional Autónoma de México.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Dadi, N.C.T.; Radochová, B.; Vargová, J.; Bujdáková, H. Impact of Healthcare-Associated Infections Connected to Medical Devices-An Update. Microorganisms 2021, 9, 2332. [Google Scholar] [CrossRef] [PubMed]
  2. Raoofi, S.; Pashazadeh Kan, F.; Rafiei, S.; Hosseinipalangi, Z.; Noorani Mejareh, Z.; Khani, S.; Abdollahi, B.; Seyghalani Talab, F.; Sanaei, M.; Zarabi, F.; et al. Global prevalence of nosocomial infection: A systematic review and meta-analysis. PLoS ONE 2023, 18, e0274248. [Google Scholar] [CrossRef]
  3. World Health Organization. Report on the Burden of Endemic Health Care-Associated Infection Worldwide. 2011. Available online: https://apps.who.int/iris/bitstream/handle/10665/80135/?sequence=1 (accessed on 8 July 2025).
  4. World Health Organization. Global Report on Infection Prevention and Control 2024; World Health Organization: Geneva, Switzerland, 2024; Available online: https://www.who.int/publications/i/item/9789240103986 (accessed on 17 November 2025).
  5. Kollef, M.H.; Torres, A.; Shorr, A.F.; Martin-Loeches, I.; Micek, S.T. Nosocomial Infection. Crit. Care Med. 2021, 49, 169–187. [Google Scholar] [CrossRef]
  6. Haque, M.; Sartelli, M.; McKimm, J.; Abu Bakar, M. Health care-associated infections—An overview. Infect. Drug Resist. 2018, 11, 2321–2333. [Google Scholar] [CrossRef] [PubMed]
  7. Miller, W.R.; Arias, C.A. ESKAPE pathogens: Antimicrobial resistance, epidemiology, clinical impact and therapeutics. Nat. Rev. Microbiol. 2024, 22, 598–616. [Google Scholar] [CrossRef] [PubMed]
  8. Sati, H.; Carrara, E.; Savoldi, A.; Hansen, P.; Garlasco, J.; Campagnaro, E.; Boccia, S.; Castillo-Polo, J.A.; Magrini, E.; Garcia-Vello, P.; et al. The WHO Bacterial Priority Pathogens List 2024: A prioritisation study to guide research, development, and public health strategies against antimicrobial resistance. Lancet Infect Dis. 2025, 25, 1033–1043. [Google Scholar] [CrossRef]
  9. Bertagnolio, S.; Dobreva, Z.; Centner, C.M.; Olaru, I.D.; Donà, D.; Burzo, S.; Huttner, B.D.; Chaillon, A.; Gebreselassie, N.; Wi, T.; et al. WHO global research prioritiesfor antimicrobial resistance in human health. Lancet Microbe 2024, 5, 100902. [Google Scholar] [CrossRef]
  10. Ahuatzin-Flores, O.E.; Torres, E.; Chávez-Bravo, E. Acinetobacter baumannii, a Multidrug-Resistant Opportunistic Pathogen in New Habitats: A Systematic Review. Microorganisms 2024, 12, 644. [Google Scholar] [CrossRef] [PubMed]
  11. Cavallo, I.; Oliva, A.; Pages, R.; Sivori, F.; Truglio, M.; Fabrizio, G.; Pasqua, M.; Pimpinelli, F.; Di Domenico, E.G. Acinetobacter baumannii in the critically ill: Complex infections get complicated. Front. Microbiol. 2023, 14, 1196774. [Google Scholar] [CrossRef]
  12. Castillo-Ramírez, S.; Aguilar-Vera, A.; Kumar, A.; Evans, B. Acinetobacter baumannii: Much more than a human pathogen. Antimicrob. Agents Chemother. 2025, 69, e0080125. [Google Scholar] [CrossRef]
  13. Mancilla-Rojano, J.; Ochoa, S.A.; Reyes-Grajeda, J.P.; Flores, V.; Medina-Contreras, O.; Espinosa-Mazariego, K.; Parra-Ortega, I.; Rosa-Zamboni, D.; Castellanos-Cruz, M.D.C.; Arellano-Galindo, J.; et al. Molecular Epidemiology of Acinetobacter calcoaceticus-Acinetobacter baumannii Complex Isolated from Children at the Hospital Infantil de México Federico Gómez. Front. Microbiol. 2020, 11, 576673. [Google Scholar] [CrossRef]
  14. Humberto, B.C.; Luis, L.A.; Josefina, D.B. Genomic analysis of the main epidemiological lineages of Acinetobacter baumannii in Mexico. Front. Cell Infect. Microbiol. 2025, 14, 1499839. [Google Scholar] [CrossRef] [PubMed]
  15. Alcántar-Curiel, M.D.; Rosales-Reyes, R.; Jarillo-Quijada, M.D.; Gayosso-Vázquez, C.; Fernández-Vázquez, J.L.; Toledano-Tableros, J.E.; Giono-Cerezo, S.; Garza-Villafuerte, P.; López-Huerta, A.; Vences-Vences, D.; et al. Carbapenem-Resistant Acinetobacter baumannii in Three Tertiary Care Hospitals in Mexico: Virulence Profiles, Innate Immune Response and Clonal Dissemination. Front. Microbiol. 2019, 10, 2116. [Google Scholar] [CrossRef] [PubMed]
  16. Garza-González, E.; Bocanegra-Ibarias, P.; Bobadilla-Del-Valle, M.; Ponce-de-León-Garduño, L.A.; Esteban-Kenel, V.; Silva-Sánchez, J.; Garza-Ramos, U.; Barrios-Camacho, H.; López-Jácome, L.E.; Colin-Castro, C.A.; et al. Drug resistance phenotypes and genotypes in Mexico in representative gram-negative species: Results from the infivar network. PLoS ONE 2021, 16, e0248614. [Google Scholar] [CrossRef] [PubMed]
  17. Universidad Autónoma de Mexico. Plan Universitario de Control de la Resistencia Antimicrobiana (PUCRA). Resistencia Antimicrobiana en México 2017 a 2023. Reporte de Los Hospitales de la Red PUCRA: Resistencia Antimicrobiana y Consumo de Antibióticos. Ciudad de México, Octubre 2024. Available online: https://puiree.cic.unam.mx/divulgacion/docs/pucra2024.pdf (accessed on 14 November 2025).
  18. Villarreal-Cruz, S.; Camacho-Ortiz, A.; Flores-Treviño, S.; Villarreal-Treviño, L.; Bocanegra-Ibarias, P. Intrahospital dissemination of multidrug-resistant Acinetobacter baumannii at a teaching hospital in Northeast of Mexico. Infect. Prev. Pract. 2025, 7, 100443. [Google Scholar] [CrossRef]
  19. Uc-Cachón, A.H.; Gracida-Osorno, C.; Luna-Chi, I.G.; Jiménez-Guillermo, J.G.; Molina-Salinas, G.M. High Prevalence of Antimicrobial Resistance Among Gram-Negative Isolated Bacilli in Intensive Care Units at a Tertiary-Care Hospital in Yucatán Mexico. Medicina 2019, 55, 588. [Google Scholar] [CrossRef]
  20. Uc-Cachón, A.H.; Molina-Salinas, G.M.; Dzul-Beh, A.J.; Rosado-Manzano, R.F.; Dzib-Baak, H.E. Bacterias Gram-negativas de prioridad crítica en pacientes de las UCI de un hospital de tercer nivel [Gram-negative bacteria of critical priority in ICU patients from a tertiary care hospital]. Rev. Med. Inst. Mex. Seguro Soc. 2023, 61, 552–558. [Google Scholar]
  21. Ardoino, I.; Zangirolami, F.; Iemmi, D.; Lanzoni, M.; Cargnelutti, M.; Biganzoli, E.; Castaldi, S. Risk factors and epidemiology of Acinetobacter baumannii infections in a university hospital in Northern Italy: A case-control study. Am. J. Infect. Control 2016, 44, 1600–1605. [Google Scholar] [CrossRef]
  22. Al-Gethamy, M.M.; Faidah, H.S.; Adetunji, H.A.; Haseeb, A.; Ashgar, S.S.; Mohanned, T.K.; Mohammed, A.-H.; Khurram, M.; Hassali, M.A. Risk factors associated with multi-drug-resistant Acinetobacter baumannii nosocomial infections at a tertiary care hospital in Makkah, Saudi Arabia-a matched case–control study. J. Int. Med. Res. 2017, 45, 1181–1189. [Google Scholar] [CrossRef]
  23. Schlosser, B.; Weikert, B.; Fucini, G.B.; Kohlmorgen, B.; Kola, A.; Weber, A.; Thoma, N.; Behnke, M.; Schwab, F.; Gastmeier, P.; et al. Risk factors for transmission of carbapenem-resistant Acinetobacter baumannii in outbreak situations: Results of a case-control study. BMC Infect. Dis. 2024, 24, 120. [Google Scholar] [CrossRef]
  24. Magiorakos, A.P.; Srinivasan, A.; Carey, R.B.; Carmeli, Y.; Falagas, M.E.; Giske, C.G.; Harbarth, S.; Hindler, J.F.; Kahlmeter, G.; Olsson-Liljequist, B.; et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin. Microbiol. Infect. 2012, 18, 268–281. [Google Scholar] [CrossRef]
  25. Playford, E.G.; Craig, J.C.; Iredell, J.R. Carbapenem-resistant Acinetobacter baumannii in intensive care unit patients: Risk factors for acquisition, infection and their consequences. J. Hosp. Infect. 2007, 65, 204–211. [Google Scholar] [CrossRef]
  26. Huertas Vaquero, M.; Asencio Egea, M.A.; Carranza González, R.; Padilla Serrano, A.; Conde García, M.C.; Tenias Burillo, J.M.; Redondo González, O. Association between antibiotic pressure and the risk of colonization/infection by multidrug-resistant Acinetobacter baumannii complex: A time series analysis. Rev. Esp. Quimioter. 2021, 34, 623–630. [Google Scholar] [CrossRef]
  27. Gu, Y.; Jiang, Y.; Zhang, W.; Yu, Y.; He, X.; Tao, J.; Hou, X.; Wang, H.; Deng, M.; Zhou, M.; et al. Risk factors and outcomes of bloodstream infections caused by Acinetobacter baumannii: A case-control study. Diagn. Microbiol. Infect. Dis. 2021, 99, 115229. [Google Scholar] [CrossRef]
  28. Combes, A.; Luyt, C.E.; Trouillet, J.L.; Nieszkowska, A.; Chastre, J. Gender impact on the outcomes of critically ill patients with nosocomial infections. Crit. Care Med. 2009, 37, 2506–2511. [Google Scholar] [CrossRef] [PubMed]
  29. Dossett, L.A.; Swenson, B.R.; Heffernan, D.; Bonatti, H.; Metzger, R.; Sawyer, R.G.; May, A.K. High levels of endogenous estrogens are associated with death in the critically injured adult. J. Trauma. 2008, 64, 580–585. [Google Scholar] [CrossRef] [PubMed]
  30. Pieracci, F.; Hydo, L.; Eachempati, S.; Pomp, A.; Shou, J.; Barie, P.S. Higher body mass index predicts need for insulin but not hyperglycemia, nosocomial infection, or death in critically ill surgical patients. Surg. Infect. 2008, 9, 121–130. [Google Scholar] [CrossRef]
  31. Antunes, L.C.; Visca, P.; Towner, K.J. Acinetobacter baumannii: Evolution of a global pathogen. Pathog. Dis. 2014, 71, 292–301. [Google Scholar] [CrossRef] [PubMed]
  32. Martínez-Hernández, E.; Sánchez-Velázquez, L.D.; Rodríguez-Terán, G. Acinetobacter baumannii, un patógeno emergente: Estudio prospectivo en una unidad de terapia intensiva respiratoria. Col. Mex. Med. Crít. 2016, 30, 187–191. [Google Scholar]
  33. Real, C.; Peralta, L. Todos los caminos conducen a la pérdida de masa muscular: Desnutrición, fragilidad, sarcopenia y caquexia. Diaeta 2021, 39, 45–58. [Google Scholar]
  34. Schneider, S.M.; Veyres, P.; Pivot, X.; Soummer, A.M.; Jambou, P.; Filippi, J.; van Obberghen, E.; Hébuterne, X. Malnutrition is an independent factor associated with nosocomial infections. Br. J. Nutr. 2004, 92, 105–111. [Google Scholar] [CrossRef] [PubMed]
  35. Sosa Hernández, Ó.; González Martínez, J.; Juárez Vargas, R.; Sánchez Rivas, M.P.; Cureño Díaz, M.A. Infecciones asociadas a la atención de la salud por bacterias del grupo ESKAPE en un hospital de la Ciudad de México. Enferm. Infecc. Microbiol. 2019, 39, 59–64. [Google Scholar]
  36. Rodriguez Buenahora, R.D.; Bustillo Zarate, D.E.; Caicedo Sanchez, D.C.; Cadena Sarmiento, D.C.; Castellanos Gomez, C. Acinetobacter baumannii: Patógeno multirresistente emergente. Med. UIS 2016, 29, 113–135. [Google Scholar] [CrossRef]
  37. Zuniga-Moya, J.C.; Caballero, C.A.; Loucel-Linares, M.; Benitez, M.J.; Zambrano-Garcia, E.; Fajardo, L.V.; Paz, J.S.; Bejarano, S.A.; Saavedra, E.B.; Romero, L.E. Antimicrobial profile of Acinetobacter baumannii at a tertiary hospital in Honduras: A cross-sectional analysis. Rev. Panam. Salud Publica 2020, 44, e46. [Google Scholar] [CrossRef]
  38. Swe-Han, K.S.; Mlisana, K.P.; Pillay, M. Analysis of clinical and microbiological data on Acinetobacter baumannii strains assist the preauthorization of antibiotics at the patient level for an effective antibiotic stewardship program. J. Infect. Public Health 2017, 10, 608–616. [Google Scholar] [CrossRef]
  39. Velázquez-Acosta, C.; Cornejo-Juárez, P.; Volkow-Fernández, P. Cepas E-ESKAPE multidrogorresistentes aisladas en hemocultivos de pacientes con cáncer [Multidrug resistance E-ESKAPE strains isolated from blood cultures in patients with cancer]. Salud Publica Mex. 2018, 60, 151–157. [Google Scholar] [CrossRef]
  40. René, C.A.J.; Arturo, R.R. Resistencia antimicrobiana de bacterias cultivadas en la Unidad de Cuidados Intensivos de Adultos. Enferm. Infecc. Microbiol. 2012, 32, 127–133. [Google Scholar]
  41. de Arriba Fernández, A.; Molina-Cabrillana, J.; Serra-Majem, L. Aplicación del cuestionario de autoevaluación de la estrategia multimodal de la OMS para mejorar la práctica de higiene de manos en un hospital de tercer nivel. Arch. Prev. Riesgos Labor. 2021, 24, 355–369. [Google Scholar] [CrossRef] [PubMed]
  42. Fernández-Cuenca, F.; Tomás-Carmona, M.; Caballero-Moyano, F.; Bou, G.; Martínez-Martínez, L.; Vila, J.; Pachón, J.; Cisneros, J.M.; Rodríguez-Baño, J.; Pascual, Á. Actividad de 18 agentes antimicrobianos frente a aislados clínicos de Acinetobacter baumannii: Segundo estudio nacional multicéntrico (proyecto GEIH-REIPI-Ab 2010). Enferm Infecc Microbiol. 2013, 31, 4–9. [Google Scholar] [CrossRef] [PubMed]
  43. Kyriakidis, I.; Vasileiou, E.; Pana, Z.D.; Tragiannidis, A. Acinetobacter baumannii Antibiotic Resistance Mechanisms. Pathogens 2021, 10, 373. [Google Scholar] [CrossRef]
  44. Vanegas-Múnera, J.M.; Roncancio-Villamil, G.; Jiménez-Quiceno, J.N. Acinetobacter baumannii: Importancia clínica, mecanismos de resistencia y diagnóstico. CES Med. 2014, 28, 233–246. [Google Scholar]
  45. Torres, A.H.; Vázquez, E.G.; Yagüe, G.; Gómez, J.G. Acinetobacter baumannii multirresistente: Situación clínica actual y nuevas perspectivas. Rev. Esp. Quimioter. 2010, 23, 12–19. [Google Scholar] [PubMed]
  46. Ren, J.; Li, X.; Wang, L.; Liu, M.; Zheng, K.; Wang, Y. Risk Factors and Drug Resistance of the MDR Acinetobacter Baumannii in Pneumonia Patients in ICU. Open Med. 2019, 14, 772–777. [Google Scholar] [CrossRef] [PubMed]
  47. Yehya, A.; Ezzeddine, Z.; Chakkour, M.; Dhaini, Z.; Bou Saba, M.S.; Bou Saba, A.S.; Nohra, L.; Nassar, N.B.; Yassine, M.; Bahmad, H.F.; et al. The intricacies of Acinetobacter baumannii: A multifaceted comprehensive review of a multidrug-resistant pathogen and its clinical significance and implications. Front. Microbiol. 2025, 16, 1565965. [Google Scholar] [CrossRef]
  48. Sharma, R.; Lakhanpal, D. Acinetobacter baumannii: A comprehensive review of global epidemiology, clinical implications, host interactions, mechanisms of antimicrobial resistance and mitigation strategies. Microbial Pathog. 2025, 204, 107605. [Google Scholar] [CrossRef]
Diseases 13 00384 g001
Figure 1. Frequency of healthcare-associated infections attributed to ESKAPE-E pathogens among patients at the IMSS Yucatán Third-Level Hospital between 2018 and 2022.
Figure 1. Frequency of healthcare-associated infections attributed to ESKAPE-E pathogens among patients at the IMSS Yucatán Third-Level Hospital between 2018 and 2022.
Diseases 13 00384 g001
Diseases 13 00384 g002
Figure 2. Prevalence of healthcare-associated infections caused by A. baumannii in comparison with those caused by the rest of the ESKAPE-E pathogens among patients at the IMSS Yucatán Third-Level Hospital from 2018 to 2022.
Figure 2. Prevalence of healthcare-associated infections caused by A. baumannii in comparison with those caused by the rest of the ESKAPE-E pathogens among patients at the IMSS Yucatán Third-Level Hospital from 2018 to 2022.
Diseases 13 00384 g002
Table 1. Selection criteria for cases and control groups.
Table 1. Selection criteria for cases and control groups.
Selection CriteriaCasesControls
Inclusion
-
Patients with a hospital stay exceeding 48 h
-
Patients with HAIs caused by A. baumannii during the study period
-
Availability of antibiogram
-
Patients with a hospital stay exceeding 48 h
-
Patients with HAIs caused by the other ESKAPE-E bacteria during the study period
-
Availability of antibiogram
Exclusion
-
Patients with healthcare-associated infections developed outside the hospital
-
Patients with healthcare-associated infections by multiple microorganisms
-
Patients experiencing reinfection or recurrence
-
Patients with healthcare-associated infections developed outside the hospital
-
Patients with healthcare-associated infections by multiple microorganisms
-
Patients experiencing reinfection or recurrence
Table 2. Sociodemographic and clinical characteristics of patients and risk factors associated with healthcare-associated infections caused by A. baumannii vs. those caused by the other ESKAPE-E pathogens.
Table 2. Sociodemographic and clinical characteristics of patients and risk factors associated with healthcare-associated infections caused by A. baumannii vs. those caused by the other ESKAPE-E pathogens.
Sociodemographic and Clinical
Characteristics		A. baumannii
n (%)		ESKPE-E
n (%)		p-ValueOR
Male45 (83.3%)90 (83.3%)1.000
Avg. Age (years)39.2 SD ± 26.639.8 SD ± 26.8
Age (years) 0.377
0–511 (20.4%)24 (22.2)
6–112 (3.7%)0 (0.0%)
12–182 (3.7%)8 (7.4%)
19–261 (1.9%)4 (3.7%)
27–5921 (38.9%)40 (37.0%)
60 and more17 (31.5%)32 (29.6%)
Type of HAIs 0.161
VAP27 (50.0%)54 (50.0%)
CLABSI16 (29.6%)32 (29.6%)
SSI5 (9.3%)10 (9.3%)
CAUTI5 (9.3%)10 (9.3%)
NV-HAP1 (1.9%)2 (1.9%)
Comorbidities 0.102
Hypertension24 (44.4%)36 (33.3%)0.1731.600
Diabetes mellitus13 (24.1%)26 (24.1%)1.0001.000
Oncohaematological diseases9 (16.7%)12 (11.1%)0.3311.600
Underweight9 (16.7%)9 (8.3%)0.1202.200
Cardiopathy3 (5.6%)11 (10.2%)0.3890.519
Chronic kidney disease3 (5.6%)5 (4.6%)1.0001.212
Rheumatological diseases2 (3.7%)1 (0.9%)0.2584.115
Obesity2 (3.7%)1 (0.9%)0.2584.115
Cancer1 (1.9%)5 (4.6%)0.6650.389
Asthma1 (1.9%)2 (1.9%)1.0001.000
HIV1 (1.9%)1 (0.9%)1.0002.019
Invasive Procedures
Central venous catheter53 (98.1%)97 (89.8%)0.0636.01
Urinary catheter43 (79.6%)75 (69.4%)0.1931.72
Mechanical ventilation41 (75.9%)63 (58.3%)0.372.253
Avg. invasive procedures (days)
Central venous catheter14.210.20.005
Urinary catheter9.36.30.101
Mechanical ventilation9.06.60.150
Avg. of hospital stays (days)40.236.90.122
Avg. of ICU stays (days)21.422.40.196
Outcome 0.360
Hospital discharge31 (57.4%)65 (60.2%)
Death20 (37.0%)31 (28.7%)
Reference to 2nd. level hospital3 (5.6%)12 (11.1%)
Bacteria
Acinetobacter baumannii54 (100%)--
Escherichia coli--30 (27.8%)
Pseudomonas aeruginosa--28 (25.9%)
Klebsiella pneumoniae--27 (25.0%)
Staphylococcus aureus--16 (14.8%)
Enterococcus faecalis--7 (6.5%)
Drug-resistant Profile
Acinetobacter baumannii
MDR5 (9.3%)--
XDR49 (90.7%)--
Escherichia coli
MDR--5 (4.65%)
XDR--26 (24.1%)
Pseudomonas aeruginosa
MDR--17 (15.8%)
XDR--11 (10.1%)
Klebsiella pneumoniae
MDR--4 (3.7%)
XDR--22 (20.3%)
Staphylococcus aureus
MDR--5 (4.6%)
XDR--11 (10.3%)
Enterococcus faecalis
MDR--4 (3.7%)
XDR--3 (2.8%)
Previous Antibiotic Therapy
Penicillins: AMP6 (11.1%)7 (6.5%)
1st gen. CP: CET0 (0.0%)3 (2.8%)
2nd gen. CP: CRX0 (0.0%)6 (5.6%)
3rd gen. CP: CTX, CRO, CAZ18 (33.3%)45 (41.7%)0.143
4th gen. CP: FEP6 (11.1%)9 (8.3%)0.565
Carbapenems: MEM, IMP12 (22.2%)28 (25.9%)<0.000
Monobactams: PIP-TZ7 (13.0%)7 (6.5%)0.166
Aminoglycosides: AMK, GEN15 (27.8%)20 (18.5%)0.177
Glycopeptides: VAN14 (25.9%)18 (16.7%)0.163
Macrolides: CLI4 (7.4%)5 (4.6%)0.467
FQs: LEV, CIP, MXF29 (53.7%)42 (32.4%)0.009
Oxazolidinones: LZD13 (24.1%)5 (4.6%)<0.000
No. of Antibiotics Prescribed 0.002
Cero0 9 (9.2%)
One12 (22.2%)47 (47.5%)
Two15 (27.8%)28 (28.3%)
Three17 (31.5%)15 (15.2%)
Four 5 (9.3%)8 (8.1%)
Five to Seven5 (9.3%)1 (1.0%)
Statistical significance p < 0.05. VAP: Ventilator-associated pneumonia; CLABSI: Central line-associated bloodstream infections; SSI: Surgical site infections; CAUTI: Catheter-associated urinary tract infections; NV-HAP: Non-ventilator hospital-acquired pneumonia; HIV: Human immunodeficiency virus; FQs: Fluoroquinolones; LEV: Levofloxacin; CIP: Ciprofloxacin; MXF: Moxifloxacin; MEM: Meropenem; IMP: Imipenem; CP: Cephalosporin; CTX: Cefotaxime; CRO: Ceftriaxone; CAZ: Ceftazidime; AMK: Amikacin; GEN: Gentamicin; VAN: Vancomycin; LZD: Linezolid; PIP-TZ: Piperacillin and Tazobactam; FEP: Cefepime; AMP: Ampicillin; CLI: Clindamycin; CRX: Cefuroxime; CET: Cephalothin.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Eb-Rejón, J.d.R.; Paniagua-Sierra, J.R.; Gracida-Osorno, C.; Molina-Salinas, G.M. Hospital-Acquired Infections Caused by Acinetobacter baumannii: A Comparative Analysis of Risk Factors with Other ESKAPE-E Pathogens in a Third-Level IMSS Hospital in Yucatan Mexico. Diseases 2025, 13, 384. https://doi.org/10.3390/diseases13120384

AMA Style

Eb-Rejón JdR, Paniagua-Sierra JR, Gracida-Osorno C, Molina-Salinas GM. Hospital-Acquired Infections Caused by Acinetobacter baumannii: A Comparative Analysis of Risk Factors with Other ESKAPE-E Pathogens in a Third-Level IMSS Hospital in Yucatan Mexico. Diseases. 2025; 13(12):384. https://doi.org/10.3390/diseases13120384

Chicago/Turabian Style

Eb-Rejón, Jael del Rosario, José Ramón Paniagua-Sierra, Carlos Gracida-Osorno, and Gloria María Molina-Salinas. 2025. "Hospital-Acquired Infections Caused by Acinetobacter baumannii: A Comparative Analysis of Risk Factors with Other ESKAPE-E Pathogens in a Third-Level IMSS Hospital in Yucatan Mexico" Diseases 13, no. 12: 384. https://doi.org/10.3390/diseases13120384

APA Style

Eb-Rejón, J. d. R., Paniagua-Sierra, J. R., Gracida-Osorno, C., & Molina-Salinas, G. M. (2025). Hospital-Acquired Infections Caused by Acinetobacter baumannii: A Comparative Analysis of Risk Factors with Other ESKAPE-E Pathogens in a Third-Level IMSS Hospital in Yucatan Mexico. Diseases, 13(12), 384. https://doi.org/10.3390/diseases13120384

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Article metric data becomes available approximately 24 hours after publication online.
Back to TopTop