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Characteristics Associated with Death in Patients with Carbapenem-Resistant Acinetobacter baumannii, United States, 2012–2017

Published online by Cambridge University Press:  02 November 2020

Hannah E. Reses
Affiliation:
Centers for Disease Control and Prevention
Kelly Hatfield
Affiliation:
Centers for Disease Control and Prevention
Jesse Jacob
Affiliation:
Emory University
Chris Bower
Affiliation:
Georgia Emerging Infections Program and Foundation for Atlanta Veterans Atlanta VA Medical Center
Elisabeth Vaeth
Affiliation:
Maryland Department of Health Marion Kainer, Western Health
Jacquelyn Mounsey
Affiliation:
Vanderbilt University
Daniel Muleta
Affiliation:
Tennessee Department of Health
Medora Witwer
Affiliation:
Minnesota Department of Health
Ghinwa Dumyati
Affiliation:
University of Rochester
Emily Hancock
Affiliation:
University of New Mexico
James Baggs
Affiliation:
Centers for Disease Control and Prevention
Maroya Walters
Affiliation:
Centers for Disease Control and Prevention
Sandra Bulens
Affiliation:
Centers for Disease Control and Prevention
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Abstract

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Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is an important cause of healthcare-associated infections with limited treatment options and high mortality. To describe risk factors for mortality, we evaluated characteristics associated with 30-day mortality in patients with CRAB identified through the Emerging Infections Program (EIP). Methods: From January 2012 through December 2017, 8 EIP sites (CO, GA, MD, MN, NM, NY, OR, TN) participated in active, laboratory-, and population-based surveillance for CRAB. An incident case was defined as patient’s first isolation in a 30-day period of A. baumannii complex from sterile sites or urine with resistance to ≥1 carbapenem (excluding ertapenem). Medical records were abstracted. Patients were matched to state vital records to assess mortality within 30 days of incident culture collection. We developed 2 multivariable logistic regression models (1 for sterile site cases and 1 for urine cases) to evaluate characteristics associated with 30-day mortality. Results: We identified 744 patients contributing 863 cases, of which 185 of 863 cases (21.4%) died within 30 days of culture, including 113 of 257 cases (44.0%) isolated from a sterile site and 72 of 606 cases (11.9%) isolated from urine. Among 628 hospitalized cases, death occurred in 159 cases (25.3%). Among hospitalized fatal cases, death occurred after hospital discharge in 27 of 57 urine cases (47.4%) and 21 of 102 cases from sterile sites (20.6%). Among sterile site cases, female sex, intensive care unit (ICU) stay after culture, location in a healthcare facility, including a long-term care facility (LTCF), 3 days before culture, and diagnosis of septic shock were associated with increased odds of death in the model (Fig. 1). In urine cases, age 40–54 or ≥75 years, ICU stay after culture, presence of an indwelling device other than a urinary catheter or central line (eg, endotracheal tube), location in a LTCF 3 days before culture, diagnosis of septic shock, and Charlson comorbidity score ≥3 were associated with increased odds of mortality (Fig. 2). Conclusion: Overall 30-day mortality was high among patients with CRAB, including patients with CRAB isolated from urine. A substantial fraction of mortality occurred after discharge, especially among patients with urine cases. Although there were some differences in characteristics associated with mortality in patients with CRAB isolated from sterile sites versus urine, LTCF exposure and severe illness were associated with mortality in both patient groups. CRAB was associated with major mortality in these patients with evidence of healthcare experience and complex illness. More work is needed to determine whether prevention of CRAB infections would improve outcomes.

Funding: None

Disclosures: None

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