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Nosocomial Respiratory Tract Colonization and Infection with Aminoglycoside-Resistant Acinetobacter calcoaceticus var anitratus: Epidemiologic Characteristics and Clinical Significance

Published online by Cambridge University Press:  02 January 2015

James E. Peacock Jr. ,
LuAnne Sorrell ,
Frank D. Sottile ,
Loraine E. Price  and
William A. Rutala
James E. Peacock Jr.*
Affiliation:
Departments of Medicine, Wake Forest University Medical Center, Winston-Salem, North Carolina
LuAnne Sorrell
Affiliation:
Hospital Infection Control, Wake Forest University Medical Center, Winston-Salem, North Carolina
Frank D. Sottile
Affiliation:
Anesthesia/Critical Care, Wake Forest University Medical Center, Winston-Salem, North Carolina
Loraine E. Price
Affiliation:
Departments of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
William A. Rutala
Affiliation:
Departments of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina Hospital Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
*
Section on Infectious Diseases, Department of Medicine, Wake Forest University Medical Center, 300 South Hawthorne Road, Winstow-Salem, NC 27103
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Abstract

During the period July 1983 through December 1984, aminoglycoside-resistant Acinetobacter calcoaceticus var anitratus (ACA) were isolated from 98 patients in a university hospital. Eighty-seven percent of patients (85/98) acquired aminoglycoside-resistant ACA in the intensive care unit (ICU) and 92% (90198) of all initial isolates were from sputum. ICU patients with respiratory colonization/infection with aminoglycoside-resistant ACA were compared with matched ICU controls with other gram-negative rods in sputum. Compared with controls, the duration of ICU stay prior to colonization/infection with aminoglycoside-resistant ACA was significantly longer for cases (14.7 days υ 5.9 days, P = 0.002). Although exposures to devices and procedures were not significantly different for the two groups, cases received respiratory therapy significantly longer than did controls (14.7 days υ 6.6 days, P = 0.006). Prior to isolation of aminoglycoside-resistant ACA in sputum, cases received more cephalosporins than did controls (1.9 υ 1.2, P = 0.018); aminoglycoside usage in the two groups was comparable but cases tended to have received aminoglycoside for longer durations before colonization/infection than had controls (9.0 days υ 6.1 days, P = 0.08). Following sputum isolation of ACA, 6 of 22 cases developed ACA bacteremia compared with bacteremia in 2 of 22 controls. We conclude that factors predisposing to colonization/infection with aminoglycoside-resistant ACA were extended ICU care, prolonged respiratory therapy, and prior therapy with cephalosporins and aminoglycoside. In addition, ACA may be a more common cause of secondary bacteremia than previously appreciated.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 9 , Issue 7 , July 1988 , pp. 302 - 308
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1988

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