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Carbapenem-Resistant Acinetobacter baumannii Incidence Trends Identified Through the Emerging Infections Program, 2012–2018

Published online by Cambridge University Press:  02 November 2020

Sandra Bulens
Affiliation:
Centers for Disease Control and Prevention
Sophia Kazakova
Affiliation:
Centers for Disease Control and Prevention
Hannah E. Reses
Affiliation:
Centers for Disease Control and Prevention
Sarah Yi
Affiliation:
Centers for Disease Control and Prevention
James Baggs
Affiliation:
Centers for Disease Control and Prevention
Jesse Jacob
Affiliation:
Emory University
Chris Bower
Affiliation:
Georgia Emerging Infections Program/Foundation for Atlanta Veterans' Education and ResearchAtlanta VA Medical Center
Elisabeth Vaeth
Affiliation:
Maryland Department of Health
Marion Kainer
Affiliation:
Western Health
Jacquelyn Mounsey
Affiliation:
Vanderbilt University
Daniel Muleta
Affiliation:
Tennessee Department of Health
Wendy Bamberg
Affiliation:
Medical Epidemiology Consulting
Helen Johnston
Affiliation:
Colorado Department of Public Health and Environment
Medora Witwer
Affiliation:
Minnesota Department of Health
Meghan Maloney
Affiliation:
Connecticut Department of Public Health, Healthcare Associated Infections & Antimicrobial Resistance Program
Ghinwa Dumyati
Affiliation:
University of Rochester
Nicole Stabach
Affiliation:
Conneticut Department of Public Health, Healthcare Associated Infections & Antimicrobial Resistance Program
Rebecca Pierce
Affiliation:
Oregon Health Authority
Emily Hancock
Affiliation:
University of New Mexico
Maroya Walters
Affiliation:
Centers for Disease Control and Prevention
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Abstract

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a serious threat to patient safety due to limited treatment options and propensity to spread in healthcare settings. Using Emerging Infections Program (EIP) data, we describe changes in CRAB incidence and epidemiology. Methods: During January 2012 to December 2018, 9 sites (Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee) participated in active laboratory- and population-based surveillance. An incident case was defined as the first isolation of A. baumannii complex, in a 30-day period, resistant to ≥1 carbapenem (excluding ertapenem) from a normally sterile site or urine of a surveillance area resident. Cases were considered hospital-onset (HO) if the culture was collected >3 days after hospital admission; all others were community-onset (CO). Cases were classified as device-associated (DA) if the patient had 1 or more medical devices (ie, urinary catheter, central venous catheter (CVC), endotracheal/nasotracheal tube, tracheostomy, or another indwelling device) present in the 2 days prior to culture collection. Temporal trends were estimated using generalized linear models adjusted for age, race, sex, and EIP site. Results: Overall, 984 incident CRAB cases were identified, representing 849 patients. Among these patients, 291 (34%) were women, 510 (61%) were nonwhite, and the median age was 62 years (mean, 59; range, 0–102). Among the cases, 226 (23%) were HO; 758 (77%) were CO; and 793 (81%) were DA. Overall incidence rates in 2012 and 2018 were 1.58 (95% CI, 1.29–1.90) and 0.60 (95% CI, 0.40–0.67) per 100,000 population, respectively. There was a 15% annual decrease in incidence (adjusted rate ratio [aRR] 0.85; 95% CI: 0.82-0.88, P < .0001). Decreases were observed among sterile site (aRR 0.88; 95% CI, 0.84–0.93) and urine cases (aRR 0.83; 95% CI, 0.80–0.87). Annual decreases occurred for HO cases (aRR, 0.78; 95% CI, 0.73–0.85) and CO cases (aRR, 0.86; 95% CI, 0.83–0.9). The DA cases decreased 16% annually overall (aRR, 0.84; 95% CI, 0.81–0.88). Decreases among cases in patients with CVC (aRR, 0.85; 95% CI, 0.80–0.90) and urinary catheters (aRR, 0.84; 95% CI, 0.80–0.88) were smaller than what was seen in patients with other indwelling devices (aRR, 0.81; 95% CI, 0.77–0.86). Discussion: Overall, from 2012 to 2018, the incidence of CRAB decreased >60%. Decreases were observed in all case groups, regardless of source, infection onset location, or types of devices. Smaller annual decreases in rates of CO-CRAB than HO-CRAB suggest that there may be opportunities to accelerate prevention outside the hospital to further reduce the incidence of these difficult-to-treat infections.

Funding: None

Disclosures: None

Type
Poster Presentations
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.
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