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A Multicenter Case-Case Control Study for Risk Factors and Outcomes of Extensively Drug-Resistant Acinetobacter baumannii Bacteremia

Published online by Cambridge University Press:  10 May 2016

Tat Ming Ng ,
Christine B. Teng ,
David C. Lye  and
Anucha Apisarnthanarak
Tat Ming Ng*
Affiliation:
Department of Pharmacy, Tan Tock Seng Hospital, Singapore
Christine B. Teng
Affiliation:
Department of Pharmacy, Tan Tock Seng Hospital, Singapore Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
David C. Lye
Affiliation:
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Communicable Disease Center, Institute of Infectious Diseases and Epidemiology, Department of Infectious Disease, Tan Tock Seng Hospital, Singapore
Anucha Apisarnthanarak
Affiliation:
Division of Infectious Diseases, Faculty of Medicine, Thammasat University Hospital, Pratumthani, Thailand
*
Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433 ([email protected])
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Abstract

Objective.

Extensively drug resistant (XDR) Acinetobacter baumannii infections are increasing. Knowledge of risk factors can help to prevent these infections.

Methods.

We designed a 1: 1: 1 case-case-control study to identify risk factors for XDR A. baumannii bacteremia in Singapore and Thailand. Case group 1 was defined as having infection due to XDR A. baumannii, and case group 2 was defined as having infection due to non-XDR A. baumannii. The control group comprised patients with blood cultures obtained to determine possible infection.

Results.

There were 93 patients in each group. Pitt bacteremia score (adjusted odds ratio [aOR], 2.570 [95% confidence interval (CI), 1.528–4.322]), central venous catheters (CVCs; aOR, 12.644 [95% CI, 2.143–74.620]), use of carbapenems (aOR, 54.391 [95% CI, 3.869–764.674]), and piperacillin-tazobactam (aOR, 55.035 [95% CI, 4.803–630.613]) were independently associated with XDR A. baumannii bacteremia. In case group 2, Pitt bacteremia score (aOR, 1.667 [95% CI, 1.265–2.196]) and third-generation cephalosporins (aOR, 2.965 [95% CI, 1.224–7.182]) were independently associated with non-XDR A. baumannii bacteremia. Concurrent infections (aOR, 3.527 [95% CI, 1.479–8.411]), cancer (aOR, 3.172 [95% CI, 1.135–8.865]), and respiratory source (aOR, 2.690 [95% CI, 1.160–6.239]) were associated with an increased risk of 30-day mortality. Survivors received more active empirical therapy (16.7% vs 9.6%; P = .157), had fewer cases of XDR bacteremia (45.8% vs 52.6%; P = .452), and received higher median definitive polymyxin B doses (840,000 units vs 700,000 units; P = .339)

Conclusions.

Use of CVC and broad spectrum antibiotics were unique risk factors of XDR A. baumannii bacteremia. Effective antimicrobial stewardship together with use of a CVC bundle may reduce the incidence of these infections. Risk factors of acquisition and mortality may help identify patients for early initiation of polymyxin B therapy.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 1 , January 2014 , pp. 49 - 55
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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References

1. Peleg, AY, Seifert, H, Paterson, DL. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev 2008;21(3):538–582.CrossRefGoogle ScholarPubMed
2. Falagas, ME, Bliziotis, IA, Siempos, II. Attributable mortality of Acinetobacter baumannii infections in critically ill patients: a systematic review of matched cohort and case-control studies. Crit Care 2006;10(2):R48.CrossRefGoogle ScholarPubMed
3. Higgins, PG, Dammhayn, C, Hackel, M, Seifert, H. Global spread of carbapenem-resistant Acinetobacter baumannii . J Animicrob Chemother 2010;65(2):233–238.CrossRefGoogle ScholarPubMed
4. Kiratisin, P, Chongthaleong, A, Tan, TY, et al. Comparative in vitro activity of carbapenems against major gram-negative pathogens: results of Asia-Pacific surveillance from the COMPACT II study. Int J Antimicrob Agents 2012;39(4):311–316.CrossRefGoogle ScholarPubMed
5. Magiorakos, AP, Srinivasan, A, Carey, RB, et al. Multidrug-resis-tant, 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
6. Apisarnthanarak, A, Mundy, LM. Mortality associated with pan-drug-resistant Acinetobacter baumannii infections in Thailand. Am J Infect Control 2009;37(6):519–520.CrossRefGoogle Scholar
7. Lee, YT, Kuo, SC, Yang, SP, et al. Impact of appropriate antimicrobial therapy on mortality associated with Acinetobacter baumannii bacteremia: relation to severity of infection. Clin Infect Dis 2012;55(2):209–215.CrossRefGoogle Scholar
8. Tsai, HT, Wang, JT, Chen, CJ, Chang, SC. Association between antibiotic usage and subsequent colonization or infection of extensive drug-resistant Acinetobacter baumannii: a matched case-control study in intensive care units. Diagn Microbiol Infect Dis 2008;62(3):298–305.CrossRefGoogle ScholarPubMed
9. Park, YS, Lee, H, Lee, KS, et al. Extensively drug-resistant Acinetobacter baumannii: risk factors for acquisition and prevalent OXA-type carbapenemases—a multicentre study. Int J Animicrob Agents 2010;36(5):430–435.CrossRefGoogle ScholarPubMed
10. Ye, JJ, Huang, CT, Shie, SS, et al. Multidrug resistant Acinetobacter baumannii: risk factors for appearance of imipenem resistant strains on patients formerly with susceptible strains. PLoS ONE 2010;5(4):e9947.CrossRefGoogle ScholarPubMed
11. Kaye, KS, Harris, AD, Samore, M, Carmeli, Y. The case-case-controi study design: addressing the limitations of risk factor studies for antimicrobial resistance. Infect Control Hosp Epidemiol 2005;26(4):346–351.CrossRefGoogle ScholarPubMed
12. Kwa, AL, Tam, VH, Falagas, ME. Polymyxins: a review of the current status including recent developments. Ann Acad Med Singapore 2008;37(10):870–883.CrossRefGoogle ScholarPubMed
13. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309–332.CrossRefGoogle ScholarPubMed
14. Friedman, ND, Kaye, KS, Stout, JE, et al. Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002;137(10):791–797.CrossRefGoogle ScholarPubMed
15. Clinical Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing: twenty-first informational supplement. Approved standard M100-S21. Wayne, PA: CLSI, 2011.Google Scholar
16. Hall, WH, Ramachandran, R, Narayan, S, Jani, AB, Vijayakumar, S. An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer 2004;4:94.CrossRefGoogle ScholarPubMed
17. Chow, JW, Yu, VL. Combination antibiotic therapy versus monotherapy for gram-negative bacteraemia: a commentary. Int J Antimicrob Agents 1999;11(1):7–12.CrossRefGoogle ScholarPubMed
18. Harris, AD, Samore, MH, Carmeli, Y. Control group selection is an important but neglected issue in studies of antibiotic resistance. Ann Intern Med 2000;133(2):159.CrossRefGoogle ScholarPubMed
19. Thatrimontrichai, A, Apisarnthanarak, A, Chanvitan, P, Janjin-damai, W, Dissaneevate, S, Maneenil, G. Risk factors and outcomes of carbapenem-resistant Acinetobacter baumannii bacteremia in neonatal intensive care unit: a case-case-control study. Pediatr Infect Dis J 2013;32(2):140–145.CrossRefGoogle ScholarPubMed
20. Zarrilli, R, Di Popolo, A, Bagattini, M, et al. Clonal spread and patient risk factors for acquisition of extensively drug-resistant Acinetobacter baumannii in a neonatal intensive care unit in Italy. J Hosp Infect 2012;82(4):260–265.Google Scholar
21. Kim, YA, Choi, JY, Kim, CK, et al. Risk factors and outcomes of bloodstream infections with metallo-β-lactamase-producing Acinetobacter . Scand J Infect Dis 2008;40(3):234–240.CrossRefGoogle ScholarPubMed
22. Elias, LS, Konzen, D, Krebs, JM, Zavascki, AP. The impact of polymyxin B dosage on in-hospital mortality of patients treated with this antibiotic. J Antimicrob Chemother 2010;65(10):2231–2237.CrossRefGoogle ScholarPubMed
23. Wareham, DW, Bean, DC, Khanna, P, Hennessy, EM, Krähe, D, Ely, A, Millar, M. Bloodstream infection due to Acinetobacter spp: epidemiology, risk factors and impact of multi-drug resistance. Eur J Clin Microbiol Infect Dis 2008;27(7):607–612.CrossRefGoogle ScholarPubMed
24. Gordon, NC, Wareham, DW Multidrug-resistant Acinetobacter baumannii: mechanisms of virulence and resistance. Int J Antimicrob Agents 2010;35(3):219–226.CrossRefGoogle ScholarPubMed
25. Lee, NY, Lee, HC, Ko, NY, et al. Clinical and economic impact of multidrug resistance in nosocomial Acinetobacter baumannii bacteremia. Infect Control Hosp Epidemiol 2007;28(6):713–719.CrossRefGoogle ScholarPubMed
26. Kwon, KT, Oh, WS, Song, JH, et al. Impact of imipenem resistance on mortality in patients with Acinetobacter bacteraemia . J Antimicrob Chemother 2007;59(3):525–530.CrossRefGoogle ScholarPubMed
27. Higgins, PG, Wisplinghoff, H, Krut, O, Seifert, H. A PCR-based method to differentiate between Acinetobacter baumannii and Acinetobacter genomic species 13TU. Clin Microbiol Infect 2007;13(12):1199–1201.CrossRefGoogle ScholarPubMed
28. Tsakris, A, Ikonomidis, A, Poulou, A, et al. Clusters of imipenem-resistant Acinetobacter baumannii clones producing different carbapenemases in an intensive care unit. Clin Microbiol Infect 2008;14(6):588–594.CrossRefGoogle Scholar
29. Paterson, DL. Looking for risk factors for the acquisition of antibiotic resistance: a 21st-century approach. Clin Infect Dis 2002;34(12):1564–1567.CrossRefGoogle ScholarPubMed