TY - JOUR
T1 - Epidemiology and clinical outcomes associated with extensively drug-resistant (XDR) Acinetobacter in US Veterans' Affairs (VA) medical centers
AU - Fitzpatrick, Margaret A.
AU - Suda, Katie J.
AU - Poggensee, Linda
AU - Vivo, Amanda
AU - Wirth, Marissa
AU - Wilson, Geneva
AU - Evans, Martin
AU - Evans, Charlesnika T.
N1 - Publisher Copyright:
©
PY - 2021/3
Y1 - 2021/3
N2 - Objective: Although infections caused by Acinetobacter baumannii are often healthcare-Acquired, difficult to treat, and associated with high mortality, epidemiologic data for this organism are limited. We describe the epidemiology, clinical characteristics, and outcomes for patients with extensively drug-resistant Acinetobacter baumannii (XDRAB). Design: Retrospective cohort study Setting: Department of Veterans' Affairs Medical Centers (VAMCs) Participants: Patients with XDRAB cultures (defined as nonsusceptible to at least 1 agent in all but 2 or fewer classes) at VAMCs between 2012 and 2018. Methods: Microbiology and clinical data was extracted from national VA datasets. We used descriptive statistics to summarize patient characteristics and outcomes and bivariate analyses to compare outcomes by culture source. Results: Among 11,546 patients with 15,364 A. baumannii cultures, 408 (3.5%) patients had 667 (4.3%) XDRAB cultures. Patients with XDRAB were older (mean age, 68 years; SD, 12.2) with median Charlson index 3 (interquartile range, 1-5). Respiratory specimens (n = 244, 36.6%) and urine samples (n = 187, 28%) were the most frequent sources; the greatest proportion of patients were from the South (n = 162, 39.7%). Most patients had had antibiotic exposures (n = 362, 88.7%) and hospital or long-Term care admissions (n = 331, 81%) in the prior 90 days. Polymyxins, tigecycline, and minocycline demonstrated the highest susceptibility. Also, 30-day mortality (n = 96, 23.5%) and 1-year mortality (n = 199, 48.8%) were high, with significantly higher mortality in patients with blood cultures. Conclusions: The proportion of Acinetobacter baumannii in the VA that was XDR was low, but treatment options are extremely limited and clinical outcomes were poor. Prevention of healthcare-Associated XDRAB infection should remain a priority, and novel antibiotics for XDRAB treatment are urgently needed.
AB - Objective: Although infections caused by Acinetobacter baumannii are often healthcare-Acquired, difficult to treat, and associated with high mortality, epidemiologic data for this organism are limited. We describe the epidemiology, clinical characteristics, and outcomes for patients with extensively drug-resistant Acinetobacter baumannii (XDRAB). Design: Retrospective cohort study Setting: Department of Veterans' Affairs Medical Centers (VAMCs) Participants: Patients with XDRAB cultures (defined as nonsusceptible to at least 1 agent in all but 2 or fewer classes) at VAMCs between 2012 and 2018. Methods: Microbiology and clinical data was extracted from national VA datasets. We used descriptive statistics to summarize patient characteristics and outcomes and bivariate analyses to compare outcomes by culture source. Results: Among 11,546 patients with 15,364 A. baumannii cultures, 408 (3.5%) patients had 667 (4.3%) XDRAB cultures. Patients with XDRAB were older (mean age, 68 years; SD, 12.2) with median Charlson index 3 (interquartile range, 1-5). Respiratory specimens (n = 244, 36.6%) and urine samples (n = 187, 28%) were the most frequent sources; the greatest proportion of patients were from the South (n = 162, 39.7%). Most patients had had antibiotic exposures (n = 362, 88.7%) and hospital or long-Term care admissions (n = 331, 81%) in the prior 90 days. Polymyxins, tigecycline, and minocycline demonstrated the highest susceptibility. Also, 30-day mortality (n = 96, 23.5%) and 1-year mortality (n = 199, 48.8%) were high, with significantly higher mortality in patients with blood cultures. Conclusions: The proportion of Acinetobacter baumannii in the VA that was XDR was low, but treatment options are extremely limited and clinical outcomes were poor. Prevention of healthcare-Associated XDRAB infection should remain a priority, and novel antibiotics for XDRAB treatment are urgently needed.
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U2 - 10.1017/ice.2020.450
DO - 10.1017/ice.2020.450
M3 - Article
C2 - 32993829
AN - SCOPUS:85092337269
SN - 0899-823X
VL - 42
SP - 305
EP - 310
JO - Infection Control and Hospital Epidemiology
JF - Infection Control and Hospital Epidemiology
IS - 3
ER -