Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-19T05:33:52.478Z Has data issue: false hasContentIssue false
  • English
  • Français

Epidemiology and clinical outcomes associated with extensively drug-resistant (XDR) Acinetobacter in US Veterans’ Affairs (VA) medical centers

Published online by Cambridge University Press:  30 September 2020

Margaret A. Fitzpatrick Open the ORCID record for Margaret A. Fitzpatrick [Opens in a new window] ,
Katie J. Suda ,
Linda Poggensee ,
Amanda Vivo ,
Marissa Wirth ,
Geneva Wilson ,
Martin Evans  and
Charlesnika T. Evans
Margaret A. Fitzpatrick*
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois Department of Medicine, Division of Infectious Diseases, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Katie J. Suda
Affiliation:
Department of Veterans’ Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Linda Poggensee
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois
Amanda Vivo
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois
Marissa Wirth
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois
Geneva Wilson
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois
Martin Evans
Affiliation:
VHA MRSA/MDRO Program Office, the National Infectious Diseases Service, Patient Care Services, VA Central Office and the Lexington VA Medical Center, Lexington, Kentucky
Charlesnika T. Evans
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois VHA MRSA/MDRO Program Office, the National Infectious Diseases Service, Patient Care Services, VA Central Office and the Lexington VA Medical Center, Lexington, Kentucky Department of Internal Medicine, University of Kentucky School of Medicine, Lexington, Kentucky Center for Health Services and Outcomes Research, Department of Preventive Medicine Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
*
Author for correspondence: Margaret A. Fitzpatrick, E-mail: Margaret.fitzpatrick@va.gov
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 3 , March 2021 , pp. 305 - 310
Check for updates
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

ADDITIONAL PRESENTATION. These data were accepted as a poster presentation for the SHEA Decennial Conference 2020, presented in a supplementary publication.

References

US Department of Health and Human Services. Antibiotic resistance threats in the United States, 2019. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/biggest-threats.html. Published 2019. Accessed June 2, 2020.Google Scholar
Bulens, SN, Yi, SH, Walters, MS, et al. Carbapenem-nonsusceptible Acinetobacter baumannii, 8 US metropolitan areas, 2012–2015. Emerg Infect Dis 2018;24:727–734.CrossRefGoogle ScholarPubMed
Ramanathan, S, Suda, KJ, Fitzpatrick, MA, et al. Multidrug-resistant Acinetobacter: risk factors and outcomes in veterans with spinal cord injuries and disorders. Am J Infect Control. 2017;45:1183–1189.CrossRefGoogle ScholarPubMed
Falagas, ME, Rafailidis, PI. Attributable mortality of Acinetobacter baumannii: no longer a controversial issue. Crit Care 2007;11:134.CrossRefGoogle ScholarPubMed
Fitzpatrick, MA, Ozer, E, Bolon, MK, Hauser, AR. Influence of ACB complex genospecies on clinical outcomes in a US hospital with high rates of multidrug resistance. J Infect 2015;70:144–152.CrossRefGoogle Scholar
Magiorakos, AP, Srinivasan, A, Carey, RB, 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.CrossRefGoogle ScholarPubMed
Weiner-Lastinger, LM, Abner, S, Edwards, JR, et al. Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: summary of data reported to the National Healthcare Safety Network, 2015–2017. Infect Control Hosp Epidemiol 2020;41:1–18.CrossRefGoogle Scholar
Hsu, LY, Apisarnthanarak, A, Khan, E, Suwantarat, N, Ghafur, A, Tambyah, PA. Carbapenem-resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia. Clin Microbiol Rev 2017;30:1–22.CrossRefGoogle ScholarPubMed
Katsiari, M, Mavroidi, A, Platsouka, ED, Nikolaou, C. Extensively drug-resistant Acinetobacter baumannii bacteraemia in a multidisciplinary intensive care unit during a 6-year period: risk factors for fulminant sepsis. J Glob Antimicrob Resist 2018;14:51–57.CrossRefGoogle Scholar
Jean, SS, Hsieh, TC, Lee, WS, Hsueh, PR, Hsu, CW, Lam, C. Treatment outcomes of patients with nonbacteremic pneumonia caused by extensively drug-resistant Acinetobacter calcoaceticus–Acinetobacter baumannii complex isolates: is there any benefit of adding tigecycline to aerosolized colistimethate sodium? Medicine (Baltimore) 2018;97(39):e12278.CrossRefGoogle Scholar
Charlson, ME, Pompei, P, Ales, KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
Department of Veterans’ Affairs, Office of Rural Health website. www.ruralhealth.va.gov/aboutus/ruralvets.asp. Published 2018. Accessed July 10, 2018.Google Scholar
Nelson, RE, Schweizer, ML, Perencevich, EN, et al. Costs and mortality associated with multidrug-resistant healthcare-associated Acinetobacter infections. Infect Control Hosp Epidemiol 2016;37:1212–1218.CrossRefGoogle ScholarPubMed
Weiner, LM, Webb, AK, Limbago, B, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014. Infect Control Hosp Epidemiol 2016;37:1288–1301.CrossRefGoogle ScholarPubMed
Jernigan, JA, Hatfield, KM, Wolford, H, et al. Multidrug-resistant bacterial infections in US hospitalized patients, 2012–2017. N Engl J Med 2020;382:1309–1319.CrossRefGoogle Scholar
Goto, M, O’Shea, AMJ, Livorsi, DJ, et al. The effect of a nationwide infection control program expansion on hospital-onset gram-negative rod bacteremia in 130 Veterans’ Health Administration Medical Centers: an interrupted time-series analysis. Clin Infect Dis 2016;63:642–650.CrossRefGoogle Scholar
Guh, AY, Bulens, SN, Mu, Y, et al. Epidemiology of carbapenem-resistant Enterobacteriaceae in 7 US communities, 2012–2013. JAMA 2015;314:1479–1487.CrossRefGoogle ScholarPubMed
Zhanel, GG, Lawrence, CK, Adam, H, et al. Imipenem-relebactam and meropenem-vaborbactam: two novel carbapenem-β-Lactamase inhibitor combinations. Drugs 2018;78:65–98.CrossRefGoogle ScholarPubMed
Sader, HS, Castanheira, M, Flamm, RK. Antimicrobial activity of ceftazidime-avibactam against gram-negative bacteria isolated from patients hospitalized with pneumonia in US Medical Centers, 2011 to 2015. Antimicrob Agents Chemother 2017;61(4):e02083-16.CrossRefGoogle Scholar
Fitzpatrick, MA. Real-world antibiotic needs for resistant gram-negative infections. The Lancet Infectious Diseases 2020 June 4. doi: 10.1016/S1473-3099(20)30178-X.CrossRefGoogle ScholarPubMed