scholarly journals 551. Burden of Illness in Carbapenem-Resistant Acinetobacter baumannii Infections in US Hospitals (2014 to 2018)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S262-S262
Author(s):  
Jason M Pogue ◽  
Hemanth Kanakamedala ◽  
Yun Zhou ◽  
Bin Cai
Keyword(s):  
Acinetobacter Baumannii ◽  
Burden Of Illness ◽  
Positive Culture ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Patient Characteristics ◽  
Healthcare Database ◽  
Carbapenem Resistant ◽  
Discharge Status ◽  
High Level

Abstract Background Infections caused by Acinetobacter baumannii present a challenge for treating physicians due to the high level of antimicrobial resistance. The current analysis compared the burden of illness in patients infected with carbapenem-resistant (CR) vs. -susceptible (CS) strains of A. baumannii. Methods Hospitalized adult patients with microbiologically confirmed A. baumannii infections (defined as a positive culture and receipt of antibiotics between 2 days prior to 3 days after the culture) included in the Premier Healthcare Database were retrospectively evaluated. Patient characteristics including demographics, comorbidities, time of infection onset and site of infection were assessed. Comparative outcomes between CR and CS patients assessed included in-hospital mortality, length of hospital stay (LOS), ICU LOS, and discharge status. Outcomes were also stratified by site of infection. Results A total of 3,471 patients admitted between January 1, 2014 and June 30, 2018 were included. Patients with CR strains of A. baumannii were older (62 vs. 59 years), more likely to have Charlson Comorbidity Index ≥3 (63.4% vs. 56.1%), more likely admitted from a healthcare origin (30.3% vs. 11.4%) and less likely to have the onset of infection within first 48 hours of hospitalization (58% vs. 69%) than those with CS strains. CR patients had increased inpatient mortality compared with CS patients (16.3% vs. 11.0%), driven primarily by patients with bloodstream infections (42.6% vs. 12.4%, respectively, P < 0.001). CR patients had a non-significantly increased median overall LOS from the onset of infection (9 vs. 8 days, P = 0.068), were more likely to be admitted to the ICU, and were significantly less likely to be discharged home (16% vs. 47%, P < 0.001). Hospitalization charges were considerably higher for CR patients (table). Readmission rates were high among CR patients and were similar to patients with CS infections. Conclusion Patients with CR strains of A. baumannii face a greater burden of illness compared with CS patients, experiencing increased mortality, ICU admission and LOS, and incur higher hospitalization charges. Furthermore, CR patients were less likely to be discharged home after admission. Disclosures All authors: No reported disclosures.

scholarly journals Multicity Outbreak of Carbapenem-Resistant Acinetobacter baumannii Isolates Producing the Carbapenemase OXA-40

2006 ◽  
Vol 50 (9) ◽  
pp. 2941-2945 ◽  
Author(s):  
Karen Lolans ◽  
Thomas W. Rice ◽  
L. Silvia Munoz-Price ◽  
John P. Quinn
Keyword(s):  
Acinetobacter Baumannii ◽  
Carbapenem Resistance ◽  
The United States ◽  
Nucleotide Sequencing ◽  
Sequencing Analysis ◽  
Carbapenem Resistant ◽  
Extended Care ◽  
Care Facilities ◽  
High Level ◽  
First Time

ABSTRACT During 2005 we detected a multicity outbreak of infections or colonization due to high-level imipenem-resistant Acinetobacter baumannii (MIC, 64 μg/ml). One hundred isolates from diverse sources were obtained from seven acute-care hospitals and two extended-care facilities; 97% of the isolates belonged to one clone. Susceptibility testing of the first 42 isolates (January to April 2005) revealed broad resistance profiles. Half of the isolates were susceptible to ceftazidime, with many isolates susceptible only to colistin. The level of AmpC β-lactamase expression was stronger in isolates resistant to ceftazidime. PCR and subsequent nucleotide sequencing analysis identified bla OXA-40. The presence of an OXA-40 β-lactamase in these isolates correlated with the carbapenem resistance. By Southern blot analysis, a bla OXA-40-specific probe revealed that the gene was both plasmid and chromosomally located. This is the first time in the United States that such carbapenem resistance in A. baumannii has been attributable to a carbapenemase.

scholarly journals Infection control management and surveillance of carbapenem-resistant Gram-negative bacteria in hematopoietic stem cell recipients

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Claas Baier ◽  
Maleen Beck ◽  
Viktoria Panagiota ◽  
Catherina Lueck ◽  
Daniel Kharazipour ◽  
...  
Keyword(s):  
Infection Control ◽  
Acinetobacter Baumannii ◽  
Bloodstream Infections ◽  
Index Patient ◽  
Empiric Antibiotic Therapy ◽  
Gram Negative Bacteria ◽  
Hematopoietic Stem ◽  
Carbapenem Resistant ◽  
Empiric Antibiotic ◽  
Control Management

Abstract Hematopoietic stem cell transplantation (HSCT) is a curative treatment option for selected diseases of the hematopoietic system. In the context of HSCT, bloodstream infections caused by Gram-negative bacteria (GNB) significantly contribute to morbidity and mortality. Antibiotic treatment of bloodstream infections with carbapenem-resistant (CR) GNB presents a particular challenge. As a part of our infection control management, the admission of a patient who was known to be colonized with a CR Acinetobacter baumannii triggered an active weekly screening of all patients to determine the prevalence and potential transmission of CR GNB and CR Acinetobacter baumannii in particular. Over a 3 month period a total of 71 patients were regularly screened for colonization with CR GNB. Including the index patient, a total of three patients showed CR GNB colonization representing a prevalence of 4.2%. Nosocomial transmission of CR Acinetobacter baumannii or other CR GNB was not observed. However, the index patient developed a subsequent bloodstream infection with the CR Acinetobacter baumannii, therefore empiric antibiotic therapy based on the known resistance profile was initiated. A weekly prevalence screening for CR GNB might be an effective monitoring tool for potential transmission, may enhance existing infection control management concepts and may support the decision making for empiric antibiotic therapy.

scholarly journals 681. Epidemiology and Outcomes of Patients with Carbapenem-Resistant Bloodstream Infection in United States Hospitals, 2010–2015

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S245-S246
Author(s):  
Roger Echols ◽  
Frank Corvino ◽  
Bin Cai ◽  
Thomas P Lodise
Keyword(s):  
Cohort Analysis ◽  
Carbapenem Resistance ◽  
Bloodstream Infections ◽  
Study Patient ◽  
Research Support ◽  
Healthcare Database ◽  
Lengths Of Stay ◽  
Carbapenem Resistant ◽  
Retrospective Cohort Analysis ◽  
Comorbidity Index

Abstract Background Carbapenem resistance (CR) in patients with Gram-negative (GN) bloodstream infections (BSI) presents a mounting therapeutic challenge. To gain a better understanding of CR among patients in US hospitals, we explored their characteristics and outcomes. Methods We performed a retrospective cohort analysis of consecutive adult patients (age ≥18 years) with a positive blood culture for GN pathogens (11 most prevalent pathogens reported in ~53,811 study patient samples), hospitalized in one of 181 institutions contributing microbiology data to the Premier Healthcare Database (October 2010–September 2015). We compared patients with CR vs. carbapenem-susceptible (CS) BSIs based on their characteristics and outcomes. Primary outcome was mortality, and secondary outcomes included post-index culture hospital and ICU lengths of stay (LOS), and likelihood of being discharged home. Results Of the ~53,811 study patient samples, 46,381 patients had a GN BSI, with the prevalence of CR occurring at 3.5% (n = 1,602). Compared with patients with CS, those with CR were younger (mean/SD 60.4/17.1 vs. 67.4/16.4 years, P &lt; 0.01), more likely to be male (52.8% vs. 45.9%, P &lt; 0.01), black (22.7% vs. 17.7%, P &lt; 0.01), and had Medicaid as a payor (18.1% vs. 10.9%, P &lt; 0.01). The mean/SD Charlson Comorbidity Index was higher in CR than CS group (2.9/2.5 vs. 2.3/2.5, P &lt; 0.01). Crude mortality was also higher (20.6% vs. 9.7%, P &lt; 0.01) in the setting of CR than CS, as were unadjusted median (IQR) post-index culture hospital (9 [6, 15] vs. 7 [5, 10] days, P &lt; 0.01), and ICU (5 [2, 11] vs. 3 [2, 6] days, P &lt; 0.01) LOS. Patients with CR BSI were less likely to be discharged home than those with CS (32.7% vs. 53.8%, P &lt; 0.001). Conclusion Patients with CR BSIs have lower likelihood of surviving hospitalization or being discharged home, and longer post-index culture hospital and ICU LOS, compared with those with CS BSIs. This highlights the need for better and more preventive and therapeutic strategies aimed at combating GN CR. Disclosures A. F. Shorr, Astellas: Consultant and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium Cidara: Consultant, Consulting fee. Merck & Co.: Consultant and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium. T. P. Lodise Jr., Motif BioSciences: Board Member, Consulting fee.

scholarly journals Bloodstream infections caused by carbapenem-resistant Acinetobacter baumannii: Clinical features, therapy and outcome from a multicenter study

2019 ◽  
Vol 79 (2) ◽  
pp. 130-138 ◽  
Author(s):  
Alessandro Russo ◽  
Matteo Bassetti ◽  
Giancarlo Ceccarelli ◽  
Novella Carannante ◽  
Angela Raffaella Losito ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Clinical Features ◽  
Multicenter Study ◽  
Bloodstream Infections ◽  
Carbapenem Resistant

scholarly journals 848. Trends of Carbapenem Resistance in Enterobacterales in the US Between 2015 and 2019

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S464-S464
Author(s):  
Stephen Marcella ◽  
Hemanth Kanakamedala ◽  
Yun Zhou ◽  
Bin Cai ◽  
Jason M Pogue
Keyword(s):  
Treatment Options ◽  
Panel Member ◽  
Carbapenem Resistance ◽  
Patient Characteristics ◽  
Independent Contractor ◽  
Healthcare Database ◽  
Patient Demographics ◽  
Carbapenem Resistant ◽  
Low Incidence ◽  
The Impact

Abstract Background Carbapenem-resistant Enterobacterales (CRE) are considered an urgent threat to human health by the CDC. Tracking resistance over time is of importance to understand trends and patterns. Tracking carbapenem resistance is complicated by definitions which include resistance to ertapenem only which can differ in epidemiology, mechanism, and treatment options. This study examines trends of CRE from 2015 to 2019 and the impact of carbapenem resistance on outcomes. Methods Enterobacterales infections identified in the Premiere HealthCare database from 2015 to 2019 were categorized into 3 groups: ertapenem only resistant (Erta-R); isolates resistant to ertapenem and class 2 carbapenems (CR-1/2); and carbapenem susceptible (CS). Trends in resistance over the study period were assessed. Furthermore, patient characteristics and outcomes were compared between groups. Results Among 225,457 unique cultures 692 were Erta-R, 2,397 were CRE-1/2, and 222,368 were CS. Overall rates of CRE-1/2 slightly increased from 0.9% to 1.2% over the study period (P for trend of &lt; 0.0001) while there was a slight negative trend for Erta-R rates (P for trend =0.006). Rates of CR by pathogen (Figures 1 and 2) were relatively stable over the study period. Enterobacter cloacae was the most common organism in the Erta-R group and K. pneumoniae was the most common CRE-1/2 pathogen. Differences in patient characteristics were seen between the three groups for race, gender, and comorbidities (Table). Both mortality (Erta-R: 10%, CRE-1/2: 9% vs CS: 4%, respectively) and infection-associated length of stay (Erta-R: 8 days; CRE-1/2: 8 days vs CS: 6 days, respectively) were higher in both Erta-R and CRE 1/2 when compared to CS (P&lt; 0.001). There were no differences in outcomes between patients with Erta-R and CRE 1/2. Figure 1. Annual rates of CRE (resistance to both classes) by pathogen over the study period Figure 2. Annual rates of CRE (ertapenem R only) by pathogen over the study period Table. Patient demographics and outcomes Conclusion CRE rates were relatively stable over the study period. Despite low incidence, CRE continue to have significant associations with morbidity and mortality. Interestingly, outcomes were similar in patients with isolates resistant to ertapenem only when compared to isolates resistant to both classes of carbapenems. This might be reflective of novel treatment options available over the study period. Disclosures Stephen Marcella, MD, Shionogi Inc. (Employee) Hemanth Kanakamedala, BS, Shionogi Inc. (Independent Contractor) Yun Zhou, MS, Shionogi Inc. (Independent Contractor) Bin Cai, MD, PhD, Shionogi Inc. (Employee) Jason M Pogue, PharmD, BCPS, BCIDP, Shionogi Inc. (Advisor or Review Panel member)

scholarly journals Co-infection of ST2IP carbapenem-resistant Acinetobacter baumannii with SARS-CoV-2 in the patients admitted to a Tehran tertiary referral hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alireza Abdollahi ◽  
Amir Aliramezani ◽  
Mohammadreza Salehi ◽  
Mahsa Norouzi Shadehi ◽  
Sedighe Ghourchian ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Genetic Relatedness ◽  
Carbapenem Resistance ◽  
Underlying Disease ◽  
Referral Hospital ◽  
Clinical Samples ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
Carbapenem Resistant ◽  
High Level

Abstract Background Carbapenem-resistant Acinetobacter baumannii (CRAB) is among the most concerning cause of healthcare-associated infections (HAI) due to its high level of antibiotic resistance and high mortality. In the era of the COVID-19 pandemic, the key priority of infection control committees is to contain the dissemination of antibiotic resistant Gram-negative bacteria. Here, we aimed to timely recognize the emergence of CRAB in COVID-19 cases admitted to the wards of a tertiary referral hospital and to identify the genetic relatedness of the isolates. Methods From 30 March to 30 May 2020, a total of 242 clinical samples from COVID-19 cases were screened for CRAB isolates using standard microbiologic and antibiotic susceptibility tests. The PCRs targeting oxa23, oxa24, oxa58, blaTEM and blaNDM-1 genes were performed. Two multiplex PCRs for identifying the global clones (GC) of A. baumannii were also performed. The sequence type of CRABs was determined using Institut Pasteur (IP) multilocus sequence typing (MLST) scheme. Results Eighteen CRAB isolates were recovered from COVID-19 patients with the mean age of 63.94 ± 13.8 years. All but 4 COVID-19 patients co-infected with CRAB were suffering from an underlying disease. Death was recorded as the outcome in ICUs for 9 (50%) COVID-19 patients co-infected with CRAB. The CRAB isolates belong to GC2 and ST2IP and carried the oxa23 carbapenem resistance gene. Conclusion This study demonstrated the co-infection of CRAB isolates and SARS-CoV-2 in the patients admitted to different ICUs at a referral hospital in Tehran. The CRAB isolates were found to belong to ST2IP, share the oxa23 gene and to have caused several outbreaks in the wards admitting COVID-19 patients.

scholarly journals Clinical and Epidemiological Characteristics of Carbapenem-resistant Klebsiella Pneumoniae Infections in a Tertiary Hospital in China

2021 ◽  
Author(s):  
Zhiwen Cui ◽  
Lirui Wang ◽  
Wei Chang ◽  
Minghui Li ◽  
Yuexia Li ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Sofa Score ◽  
Positive Culture ◽  
Bloodstream Infections ◽  
Polymyxin B ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Carbapenem Resistant ◽  
Epidemiological Characteristics ◽  
Antimicrobial Regimen

Abstract Background: The infections due to carbapenem-resistant Klebsiella pneumonia (CR-KP) have become an important problem and they are associated with a high mortality rate. The aim of the study is to evaluate the clinical and epidemiological characteristics of CR-KP.Methods: A retrospective cohort study has been made on all patients presenting with CR-KP infections. 615 patients with CR-KP humor infections diagnosed between January 2018 and December 2019 were identified. 135 patients who did not meet the requirements were excluded, and the remaining 480 patients were enrolled in the study. We have evaluated the mortality in 30 days from the first positive culture. Clinical characteristics, antimicrobial regimens, and outcomes of patients have been analyzed.Results: The CR-KP infections overall mortality was 37.3%, and bloodstream infections mortality was 66.2%. Survival analysis revealed that there were statistically significant differences between bloodstream infection and pulmonary and drainage fluid infection. The gender, wards, and endotracheal intubation or tracheotomy before positive culture did not differ between the non-survivor and survivor groups. Logistics regression analysis showed that hemopathy, age (>60 years), solid tumors, diabetes, septic shock, acute kidney injury and stroke were independent predictors associated with the 30-day mortality. Multivariate linear regression was performed in APACHE II score, SOFA score, lymphocyte absolute value (LYM) and survival time. Survival time was negatively correlated with APACHE II score and SOFA score, while positively correlated with LYM. In addition, ROC curves were also drawn for APACHE II score, SOFA score and LYM, with AUC of 0.825, 0.876 and 0.797, respectively. Finally, we investigated different antimicrobial regimens for CR-KP infections. Chi-square test showed that antimicrobial regimen combined carbapenems, tigecycline with polymyxin B was superior the one combined carbapenems with polymyxin B, and the difference had statistically significant. But there was not statistically significant difference between carbapenems plus tigecycline and carbapenems plus polymyxin B, and it seemed that polymyxin B and tigecycline have synergistic effect. Ceftazidime avibactam-based antimicrobial regimens also had no advantage over other therapeutic regimens.Conclusions: Our study confirmed there is a high mortality rate in CR-KP infections, especially in the bloodstream infections. The outcome is greatly influenced by the patients’ clinical conditions. Antimicrobial regimen combined carbapenems, tigecycline with polymyxin B might be a better choice.

scholarly journals Burden of illness in carbapenem-resistant Acinetobacter baumannii infections in US hospitals between 2014 and 2019

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jason M. Pogue ◽  
Yun Zhou ◽  
Hemanth Kanakamedala ◽  
Bin Cai
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acinetobacter Baumannii ◽  
Burden Of Illness ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Carbapenem Resistant

Abstract Background Carbapenem-resistant (CR) Acinetobacter baumannii is a concerning pathogen in the USA and worldwide. Methods To assess the comparative burden of CR vs carbapenem-susceptible (CS) A. baumannii, this retrospective cohort study analyzed data from adult patients in 250 US hospitals from the Premier HealthCare Database (2014–2019). The outcomes analyzed included hospital length of stay (LOS), intensive care unit (ICU) utilization, discharge status, in-hospital mortality, readmission rates and hospital charges. Logistic regression was used for univariate and multivariable assessment of the independent relationship between relevant covariates, with a focus on CR status, and in-hospital mortality. Results 2047 Patients with CR and 3476 patients with CS A. baumannii infections were included. CR A. baumannii was more commonly isolated in respiratory tract infections (CR 40.7% and CS 27.0%, P < 0.01), whereas CS A. baumannii was more frequently associated with bloodstream infections (CS 16.7% and CR 8.6%, P < 0.01). Patients with CR A. baumannii infections had higher in-hospital (CR 16.4% vs CS 10.0%; P < 0.01) and 30-day (CR 32.2% vs CS 21.6%; P < 0.01) mortality compared to those with CS infections. After adjusting for age, sex, admission source, infection site, comorbidities, and treatment with in vitro active antibiotics within 72 h, carbapenem resistance was independently associated with increased mortality (adjusted odds ratio 1.42 [95% confidence interval 1.15; 1.75], P < 0.01). CR infections were also associated with increases in hospital length of stay (CR 11 days vs CS 9 days; P < 0.01), rate of intensive care unit utilization (CR 62.3% vs CS 45.1%; P < 0.01), rate of readmission with A. baumannii infections (CR 17.8% vs CS 4.0%; P < 0.01) and hospital charges. Conclusions These data suggest that the burden of illness is significantly greater for patients with CR A. baumannii infections and are at higher risk of mortality compared with CS infections in US hospitals.

scholarly journals Clinical and microbiological characterization of carbapenem-resistant Acinetobacter baumannii bloodstream infections

2011 ◽  
Vol 60 (5) ◽  
pp. 605-611 ◽  
Author(s):  
Joon Young Song ◽  
Hee Jin Cheong ◽  
Won Suk Choi ◽  
Jung Yeon Heo ◽  
Ji Yun Noh ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Bloodstream Infections ◽  
Carbapenem Resistant
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