Do Results of Surveillance Cultures Impact the Choice of Empirical Antibiotics Among Patients with Carbapenem-Resistant Acinetobacter baumannii Infections?

We aimed to determine whether the results of surveillance cultures were associated with use of appropriate empirical antibiotic therapy among patients with carbapenem-resistant Acinetobacter baumannii infections. We found that surveillance status was not associated with appropriate empirical antibiotic therapy (P=.36). There were significant delays to concordant therapy among surveillance-positive patients (P=.03).Infect. Control Hosp. Epidemiol. 2015;36(12):1455–1457

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Impact of Appropriate Empirical Antibiotic Therapy on Clinical Outcome in Patients With Acinetobacter baumannii Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.805 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Atakan Nemli ◽

Tuna Demirdal

Keyword(s):

Clinical Outcome ◽

Antibiotic Therapy ◽

Acinetobacter Baumannii ◽

Empirical Antibiotic Therapy

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523. Dual vs. Triple Antibiotic Therapy for Carbapenem-Resistant Acinetobacter baumannii Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.592 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S252-S252

Author(s):

Justin Patrick Markelwith ◽

Nikunj M Vyas ◽

Mark Condoluci ◽

Sungwook Kim

Keyword(s):

Combination Therapy ◽

Serum Creatinine ◽

Antibiotic Therapy ◽

Acinetobacter Baumannii ◽

Clinical Cure ◽

Group Analysis ◽

Elevated Serum ◽

Positive Association ◽

Primary Analysis ◽

Carbapenem Resistant

Abstract Background Infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) remain some of the most difficult to treat due to extremely high rates of resistance. The purpose of this study was to compare the efficacy of dual vs. triple targeted antibiotic regimens for CRAB infections. Methods This was an IRB approved retrospective cohort study performed at a 607-bed community health system between January 2016 and December 2018. Patients were included in the analysis if they were ≥18 years old and received antibiotics for CRAB for ≥72 hours. Patients were excluded if they were pregnant and had CRAB isolated solely from the urine. The primary endpoints of the study were differences in all-cause in-hospital mortality (ACIM) and clinical cure (CC) rates for patients treated with dual vs. triple antibiotic therapy. The secondary endpoint result focused on the difference in length of stay (LOS) between treatment groups. A sub-group analysis was performed for patients treated with tigecycline vs. minocycline combination therapy to determine differences ACIM and CC, and LOS. A multi-logistic regression analysis (MLRA) was performed to determine patient factors that were associated with ACIM and CC. Results A total of 32 patients were included in the primary analysis. No difference was seen in ACIM between dual vs. triple antibiotic groups (9.5% vs. 18.2%, P = 0.59). CC (63.6% vs. 57.1%, P = 1.0) and LOS (12 vs. 11 days, P = 1.0) was similar amongst patients treated with dual vs. triple antibiotic group. No differences were seen in ACIM (15.4% vs. 16.7% P = 1.0), CC (83.3% vs. 69.2%, P = 1.0) and LOS (15 vs. 14 days, P = 1.0) between tigecycline and minocycline combination therapy groups. The MLRA revealed a positive association with increased serum creatinine and ACIM (OR 3.29, 95% CI 1.35–8.04; P = 0.009) as well as shorter time to appropriate antibiotic therapy and clinical cure (OR 1.49, 95% CI 1.02–2.20; P = 0.04). CRAB isolates were more likely to be susceptible to minocycline vs. tigecycline (83% vs. 18%, P = 0.003). Conclusion No differences were seen in ACIM, CC and LOS between dual vs. triple antibiotic groups. Minocycline tends to sustain better susceptibility toward CRAB vs. tigecycline. Elevated serum creatinine was found to be a predictor for ACIM while shorter time to appropriate antibiotic therapy was associated with CC. Disclosures All authors: No reported disclosures.

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An Outbreak of Carbapenem-Resistant Acinetobacter baumannii Infection in a Neonatal Intensive Care Unit: Investigation and Control

Infection Control and Hospital Epidemiology ◽

10.1086/657669 ◽

2011 ◽

Vol 32 (1) ◽

pp. 34-41 ◽

Cited By ~ 33

Author(s):

Eric J. McGrath ◽

Teena Chopra ◽

Nahed Abdel-Haq ◽

Katherine Preney ◽

Winston Koo ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Infection Control ◽

Neonatal Intensive Care Unit ◽

Acinetobacter Baumannii ◽

Neonatal Intensive Care ◽

Multidrug Resistant ◽

Control Measures ◽

Carbapenem Resistant ◽

Surveillance Cultures

Objective.To investigate the mode of transmission of and assess control measures for an outbreak of carbapenem-resistant (multidrug-resistant) Acinetobacter baumannii infection involving 6 premature infants.Design.An outbreak investigation based on medical record review was performed for each neonate during the outbreak (from November 2008 through January 2009) in conjunction with an infection control investigation.Setting.A 36-bed, level 3 neonatal intensive care unit in a university-affiliated teaching hospital in Detroit, Michigan.Interventions.Specimens were obtained for surveillance cultures from all infants in the unit. In addition, geographic cohorting of affected infants and their nursing staff, contact isolation, re-emphasis of adherence to infection control practices, environmental cleaning, and use of educational modules were implemented to control the outbreak.Results.Six infants (age, 10-197 days) with multidrug-resistant A. baumannii infection were identified. All 6 infants were premature (gestational age, 23-30 weeks) and had extremely low birth weights (birth weight, 1000 g or less). Conditions included conjunctivitis (2 infants), pneumonia (4 infants), and bacteremia (1 infant). One infant died of causes not attributed to infection with the organism; the remaining 5 infants were discharged home. All surveillance cultures of unaffected infants yielded negative results.Conclusions.The spread of multidrug-resistant A. baumannii infection was suspected to be due to staff members who spread the pathogen through close contact with infants. Clinical staff recognition of the importance of multidrug-resistant A. baumannii recovery from neonatal intensive care unit patients, geographic cohorting of infected patients, enhanced infection control practices, and staff education resulted in control of the spread of the organism.

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Surveillance cultures following a regional outbreak of carbapenem-resistant Acinetobacter baumannii

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.162 ◽

2021 ◽

pp. 1-7

Author(s):

Frida Rivera ◽

Allison Reeme ◽

Mary Beth Graham ◽

Blake W. Buchan ◽

Nathan A. Ledeboer ◽

...

Keyword(s):

Acinetobacter Baumannii ◽

Tertiary Care ◽

Culture Method ◽

Body Site ◽

Bacterial Identification ◽

Test Results ◽

Carbapenem Resistant ◽

Surveillance Cultures ◽

Care Facilities ◽

Postacute Care

Abstract Objectives: The primary aim of this study was to assess the epidemiology of carbapenem-resistant Acinetobacter baumannii (CRAB) for 9 months following a regional outbreak with this organism. We also aimed to determine the differential positivity rate from different body sites and characterize the longitudinal changes of surveillance test results among CRAB patients. Design: Observational study. Setting: A 607-bed tertiary-care teaching hospital in Milwaukee, Wisconsin. Patients: Any patient admitted from postacute care facilities and any patient housed in the same inpatient unit as a positive CRAB patient. Methods: Participants underwent CRAB surveillance cultures from tracheostomy secretions, skin, and stool from December 5, 2018, to September 6, 2019. Cultures were performed using a validated, qualitative culture method, and final bacterial identification was performed using mass spectrometry. Results: In total, 682 patients were tested for CRAB, of whom 16 (2.3%) were positive. Of the 16 CRAB-positive patients, 14 (87.5%) were residents from postacute care facilities and 11 (68.8%) were African American. Among positive patients, the positivity rates by body site were 38% (6 of 16) for tracheal aspirations, 56% (9 of 16) for skin, and 82% (13 of 16) for stool. Conclusions: Residents from postacute care facilities were more frequently colonized by CRAB than patients admitted from home. Stool had the highest yield for identification of CRAB.

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Surveillance Cultures Growing Carbapenem-Resistant Acinetobacter baumannii Predict the Development of Clinical Infections: A Retrospective Cohort Study

Clinical Infectious Diseases ◽

10.1093/cid/ciu847 ◽

2014 ◽

Vol 60 (3) ◽

pp. 415-422 ◽

Cited By ~ 40

Author(s):

R. Latibeaudiere ◽

R. Rosa ◽

P. Laowansiri ◽

K. Arheart ◽

N. Namias ◽

...

Keyword(s):

Cohort Study ◽

Acinetobacter Baumannii ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Carbapenem Resistant ◽

Surveillance Cultures

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Efficacy of monotherapy and combined antibiotic therapy for carbapenem-resistant Acinetobacter baumannii pneumonia in an immunosuppressed mouse model

International Journal of Antimicrobial Agents ◽

10.1016/j.ijantimicag.2008.07.008 ◽

2009 ◽

Vol 33 (1) ◽

pp. 33-39 ◽

Cited By ~ 51

Author(s):

Joon Young Song ◽

Hee Jin Cheong ◽

Jacob Lee ◽

Ah Kyeong Sung ◽

Woo Joo Kim

Keyword(s):

Mouse Model ◽

Antibiotic Therapy ◽

Acinetobacter Baumannii ◽

Carbapenem Resistant ◽

Immunosuppressed Mouse

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Inadequate Empirical Antibiotic Therapy in Hospital Acquired Pneumonia

Journal of Nepal Medical Association ◽

10.31729/jnma.2738 ◽

2015 ◽

Vol 53 (200) ◽

pp. 240-243

Author(s):

Santosh Dahal ◽

Basista Prasad Rijal ◽

Karbir Nath Yogi ◽

Jeevan Bahadur Sherchand ◽

Keshab Parajuli ◽

...

Keyword(s):

Antibiotic Therapy ◽

Early Onset ◽

Late Onset ◽

Empirical Therapy ◽

Antibiotic Use ◽

Empirical Antibiotic Therapy ◽

Hospital Acquired Pneumonia ◽

Empirical Antibiotics ◽

Microsoft Office ◽

Hospital Acquired

Introduction: Inadequate empirical antibiotic therapy for HAP is a common phenomena and one of the indicators of the poor stewardship. This study intended to analyze the efficacy of empirical antibiotics in the light of microbiological data in HAP cases. Methods: Suspected cases of HAP were followed for clinico-bacterial evidence, antimicrobial resistance and pre and post culture antibiotic use. The study was taken from February,2014 to July, 2014 in department of Microbiology and department of Respiratory medicine prospectively. Data was analyzed by Microsoft Office Excel 2007. Results: Out of 758 cases investigated, 77(10 %) cases were HAP, 65(84%) of them were culture positive and 48(74 %) were late in onset. In early onset cases, isolates were Acinetobacter 10(42%), Escherichia coli 5(21%), S.aureus 4(17%), Klebsiella 1(4%) and Pseudomonas 1(4%). From the late onset cases Acinetobacter 15(28%), Klebsiella 17(32%) and Pseudomonas 13(24%) were isolated. All Acinetobacter, 78% Klebsiella and 36% Pseudomonas isolates were multi drug resistant. Empirical therapies were inadequate in 12(70%) of early onset cases and 44(92%) of late onset type. Cephalosporins were used in 7(41%) of early onset infections but found to be adequate only in 2(12%) cases. Polymyxins were avoided empirically but after cultures were used in 9(19%) cases. Conclusions: Empirical antibiotics were vastly inadequate, more frequently so in late onset infections. Use of cephalosporins empirically in early onset infections and avoiding empirical use of polymyxin antibiotics in late onset infections contributed largely to the findings. Inadequate empirical regimen is a real time feedback for a practitioner to update his knowledge on the local microbiological trends. Keywords: empirical therapy; hospital acquired pneumonia.

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842. Impact of Active Treatment of Carbapenem-Resistant Acinetobacter baumannii Infections in US Hospitals Between 2014 and 2019

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1031 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S462-S462

Author(s):

Jason M Pogue ◽

Yun Zhou ◽

Hemanth Kanakamedala ◽

Bin Cai

Keyword(s):

Antibiotic Therapy ◽

Acinetobacter Baumannii ◽

Active Treatment ◽

Panel Member ◽

Readmission Rates ◽

Independent Contractor ◽

In Vitro Susceptibility ◽

Carbapenem Resistant ◽

Discharge Status ◽

The Impact

Abstract Background Treatment choices for carbapenem-resistant (CR) Acinetobacter baumannii infections are limited. We analyzed the impact of active treatment on outcomes in patients infected with CR vs carbapenem-susceptible (CS) A. baumannii. Methods Adult patients hospitalized between January 1, 2014 and June 30, 2019 with A. baumannii infections recorded in the Premier Database were retrospectively evaluated. Outcomes including mortality, discharge status (home vs other), and readmission rates were calculated as a function of receipt of active antibiotic treatment, infection site, and CR status. Antibiotic therapy was considered active if given after the index culture and displaying in vitro susceptibility. Results Among 3,500 patients with A. baumannii (CR n=1,608; CS n=1,892), 2,057 patients (58.8%) received active treatment, with a much lower proportion of CR A. baumannii patients receiving active treatment than CS patients (606 [37.7%] vs 1,451 [76.7%]). Patients without active treatment had similar rates of in-hospital mortality (14.3% vs 12.9%, P=0.25) but were less likely to be discharged to home (26.3% vs 37.0%, P< 0.001) than those that received active treatment. No association between receipt of active treatment and overall mortality or discharged status was demonstrated for CR isolates (Table 1). However, among the subset of patients with CR bloodstream infections, mortality was higher in those without active treatment compared to those with active treatment (55.1% vs 25.9%, P=0.009). Overall readmission rates due to A. baumannii were considerably higher for those who did not receive active treatment vs those who did (16.0% vs 7.5%, P< 0.001) and the same was seen by differing infection sites; primarily driven by CR patients with bloodstream, respiratory, or urine infections (Table 2). Table 1. Mortality and discharge status by active treatment and carbapenem susceptibility Table 2. Readmission due to A. baumannii by active treatment and CR status among patients discharged alive Conclusion Active antibiotic therapy was associated with improved outcomes in patients with A. baumannii infections, although perhaps not to the extent expected. Further investigation into the impact of active therapy on outcomes is warranted. Disclosures Jason M Pogue, PharmD, BCPS, BCIDP, Shionogi Inc. (Advisor or Review Panel member) Yun Zhou, MS, Shionogi Inc. (Independent Contractor) Hemanth Kanakamedala, BS, Shionogi Inc. (Independent Contractor) Bin Cai, MD, PhD, Shionogi Inc. (Employee)

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Active Surveillance of Carbapenem-resistant Gram-negative Bacteria to guide antibiotic therapy: a single-center prospective observational study

10.21203/rs.3.rs-889531/v1 ◽

2021 ◽

Author(s):

Qiqiang Liang ◽

Juan Chen ◽

Yongshan Xu ◽

Yibing Chen ◽

Man Huang

Keyword(s):

Risk Factors ◽

Observational Study ◽

Antibiotic Therapy ◽

Prospective Observational Study ◽

Gram Negative Bacteria ◽

Empirical Antibiotic Therapy ◽

Single Center ◽

Gram Negative ◽

Factors Associated ◽

Carbapenem Resistant

Abstract Background Carbapenem-resistant Gram-negative Bacteria (CRGNB) have become a public health concern worldwide. The risk factors associated with CRGNB infection after colonization are unknown, nor is the optimal timing of antibiotic treatment, warranting further investigation. Methods A 4-year single-center prospective observational study was conducted. CRGNB-colonized patients were incorporated on admission into our observation cohort for an active surveillance culture program, and analysis of risk factors associated with infections after CRGNB colonization was performed. We divided patients into empirical antibiotic therapy groups and standard antibiotic therapy groups according to whether antibiotics were used before or after cultures yielded a result to explore the relationship between the timing of antibiotics and clinical efficacy. Results 152 out of 451 CRGNB-colonized patients in the prospective observational cohort developed CRGNB infection. The risk factors associated with CRGNB infection after colonization included CRKP (P < 0.001, OR = 3.27) and CRPA (P < 0.001, OR = 2.97) colonization, history of carbapenems use (P < 0.001, OR = 5.48), and immunocompromise (P < 0.001, OR = 7.07). There were 88 infected patients in the empirical antibiotic therapy groups and 64 in standard antibiotic therapy groups. The mortality was lower in empirical therapy groups than standard therapy groups (17.0% vs. 37.5%, P = 0.004, OR = 0.32). Conclusions CRGNB colonization increased the risk of infection, and risk factors included CRKP and CRPA colonization, immunocompromise, and prior carbapenems use. Once infection occurs in CRGNB-colonized patients, susceptibility-guided antibiotic treatment can be given according to previous susceptibility results of colonized CRGNB, reducing mortality.

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