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Open Access 01-12-2022 | Antibiotic | Research

Epidemiology and outcomes associated with carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa: a retrospective cohort study

Authors: Amanda Vivo, Margaret A. Fitzpatrick, Katie J. Suda, Makoto M. Jones, Eli N. Perencevich, Michael A. Rubin, Swetha Ramanathan, Geneva M. Wilson, Martin E. Evans, Charlesnika T. Evans

Published in: BMC Infectious Diseases | Issue 1/2022

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Abstract

Background

Carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) are a growing threat. The objective of this study was to describe CRAB and CRPA epidemiology and identify factors associated with mortality and length of stay (LOS) post-culture.

Methods

This was a national retrospective cohort study of Veterans with CRAB or CRPA positive cultures from 2013 to 2018, conducted at Hines Veterans Affairs Hospital. Carbapenem resistance was defined as non-susceptibility to imipenem, meropenem and/or doripenem. Multivariable cluster adjusted regression models were fit to assess the association of post-culture LOS among inpatient and long-term care (LTC) and to identify factors associated with 90-day and 365-day mortality after positive CRAB and CRPA cultures.

Results

CRAB and CRPA were identified in 1,048 and 8,204 unique patients respectively, with 90-day mortality rates of 30.3% and 24.5% and inpatient post-LOS of 26 and 27 days. Positive blood cultures were associated with an increased odds of 90-day mortality compared to urine cultures in patients with CRAB (OR 6.98, 95% CI 3.55–13.73) and CRPA (OR 2.82, 95% CI 2.04–3.90). In patients with CRAB and CRPA blood cultures, higher Charlson score was associated with increased odds of 90-day mortality. In CRAB and CRPA, among patients from inpatient care settings, blood cultures were associated with a decreased LOS compared to urine cultures.

Conclusions

Positive blood cultures and more comorbidities were associated with higher odds for mortality in patients with CRAB and CRPA. Recognizing these factors would encourage clinicians to treat these patients in a timely manner to improve outcomes of patients infected with these organisms.
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Literature
2.
go back to reference Fournier PE, Richet H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis. 2006;42:692–9.CrossRef Fournier PE, Richet H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis. 2006;42:692–9.CrossRef
3.
go back to reference Ramanathan S, Fitzpatrick MA, Suda KJ, Burns SP, Jones MM, LaVela SL, et al. Multidrug-resistant Gram-negative organisms and association with 1-year mortality, readmission, and length of stay in Veterans with spinal cord injuries and disorders. Spinal Cord. 2020;58(5):596–608.CrossRef Ramanathan S, Fitzpatrick MA, Suda KJ, Burns SP, Jones MM, LaVela SL, et al. Multidrug-resistant Gram-negative organisms and association with 1-year mortality, readmission, and length of stay in Veterans with spinal cord injuries and disorders. Spinal Cord. 2020;58(5):596–608.CrossRef
4.
go back to reference Wieland K, Chhatwal P, Vonberg RP. Nosocomial outbreaks caused by Acinetobacter baumannii and Pseudomonas aeruginosa: results of a systematic review. Am J Infect Control. 2018;46:643–8.CrossRef Wieland K, Chhatwal P, Vonberg RP. Nosocomial outbreaks caused by Acinetobacter baumannii and Pseudomonas aeruginosa: results of a systematic review. Am J Infect Control. 2018;46:643–8.CrossRef
5.
go back to reference Gniadek TJ, Carroll KC, Simner PJ. Carbapenem-resistant non-glucose-fermenting Gram-negative bacilli: the missing piece to the puzzle. J Clin Microbiol. 2016;54:1700–10.CrossRef Gniadek TJ, Carroll KC, Simner PJ. Carbapenem-resistant non-glucose-fermenting Gram-negative bacilli: the missing piece to the puzzle. J Clin Microbiol. 2016;54:1700–10.CrossRef
6.
go back to reference Meletis G. Carbapenem resistance: overview of the problem and future perspectives. Ther Adv Infect Dis. 2016;3:15–21.PubMedPubMedCentral Meletis G. Carbapenem resistance: overview of the problem and future perspectives. Ther Adv Infect Dis. 2016;3:15–21.PubMedPubMedCentral
7.
go back to reference Buehrle DJ, Shields RK, Clarke LG, Potoski BA, Clancy CJ, Nguyen MH. Carbapenem-resistant Pseudomonas aeruginosa bacteremia: risk factors for mortality and microbiologic treatment failure. Antimicrob Agents Chemother. 2016;61:e01243-e1316.PubMedPubMedCentral Buehrle DJ, Shields RK, Clarke LG, Potoski BA, Clancy CJ, Nguyen MH. Carbapenem-resistant Pseudomonas aeruginosa bacteremia: risk factors for mortality and microbiologic treatment failure. Antimicrob Agents Chemother. 2016;61:e01243-e1316.PubMedPubMedCentral
9.
go back to reference Cai B, Echols R, Magee G, Arjona Ferreira JC, Morgan G, Ariyasu M, et al. Prevalence of carbapenem-resistant gram-negative infections in the United States predominated by Acinetobacter baumannii and Pseudomonas aeruginosa. Open Forum Infect Dis. 2017;4(3):ofx176.CrossRef Cai B, Echols R, Magee G, Arjona Ferreira JC, Morgan G, Ariyasu M, et al. Prevalence of carbapenem-resistant gram-negative infections in the United States predominated by Acinetobacter baumannii and Pseudomonas aeruginosa. Open Forum Infect Dis. 2017;4(3):ofx176.CrossRef
10.
go back to reference Playford EG, Craig JC, Iredell JR. Carbapenem-resistant Acinetobacter baumannii in intensive care unit patients: risk factors for acquisition, infection and their consequences. J Hosp Infect. 2007;65:204–11.CrossRef Playford EG, Craig JC, Iredell JR. Carbapenem-resistant Acinetobacter baumannii in intensive care unit patients: risk factors for acquisition, infection and their consequences. J Hosp Infect. 2007;65:204–11.CrossRef
11.
go back to reference Liu Q, Li X, Li W, Du X, He JQ, Tao C, et al. Influence of carbapenem resistance on mortality of patients with Pseudomonas aeruginosa infection: a meta-analysis. Sci Rep. 2015;5:11715.CrossRef Liu Q, Li X, Li W, Du X, He JQ, Tao C, et al. Influence of carbapenem resistance on mortality of patients with Pseudomonas aeruginosa infection: a meta-analysis. Sci Rep. 2015;5:11715.CrossRef
12.
go back to reference Du X, Xu X, Yao J, Deng K, Chen S, Shen Z, et al. Predictors of mortality in patients infected with carbapenem-resistant Acinetobacter baumannii: a systematic review and meta-analysis. Am J Infect Control. 2019;47:1140–5.CrossRef Du X, Xu X, Yao J, Deng K, Chen S, Shen Z, et al. Predictors of mortality in patients infected with carbapenem-resistant Acinetobacter baumannii: a systematic review and meta-analysis. Am J Infect Control. 2019;47:1140–5.CrossRef
13.
go back to reference Liu C, Shih S, Wang N, Wu AY, Sun FJ, Chow SF, et al. Risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia. J Microbiol Immunol Infect. 2016;49:934–40.CrossRef Liu C, Shih S, Wang N, Wu AY, Sun FJ, Chow SF, et al. Risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia. J Microbiol Immunol Infect. 2016;49:934–40.CrossRef
14.
go back to reference Lin K, Lauderdale T, Wang, Chang S. Carbapenem-resistant Pseudomonas aeruginosa in Taiwan: prevalence, risk factors, and impact on outcome of infections. J Microbiol Immunol Infect. 2016;49:52–9.CrossRef Lin K, Lauderdale T, Wang, Chang S. Carbapenem-resistant Pseudomonas aeruginosa in Taiwan: prevalence, risk factors, and impact on outcome of infections. J Microbiol Immunol Infect. 2016;49:52–9.CrossRef
15.
go back to reference Weiner-Lastinger LM, Abner S, Edwards JR, Kallen AJ, Karlsson M, Magill SS, et al. Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015–2017. Infect Control Hosp Epidemiol. 2020;41(1):1–18. https://doi.org/10.1017/ice.2019.296.CrossRefPubMed Weiner-Lastinger LM, Abner S, Edwards JR, Kallen AJ, Karlsson M, Magill SS, et al. Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015–2017. Infect Control Hosp Epidemiol. 2020;41(1):1–18. https://​doi.​org/​10.​1017/​ice.​2019.​296.CrossRefPubMed
16.
go back to reference Ramanathan S, Suda KJ, Fitzpatrick MA, Guihan M, Goedken CC, Safdar N, et al. QUERI CARRIAGE Program. A survey of infection control strategies for carbapenem-resistant Enterobacteriaceae in Department of Veterans’ Affairs facilities. Infect Control Hosp Epidemiol. 2020;22:1–4.CrossRef Ramanathan S, Suda KJ, Fitzpatrick MA, Guihan M, Goedken CC, Safdar N, et al. QUERI CARRIAGE Program. A survey of infection control strategies for carbapenem-resistant Enterobacteriaceae in Department of Veterans’ Affairs facilities. Infect Control Hosp Epidemiol. 2020;22:1–4.CrossRef
17.
go back to reference Suda KJ, Patel UC, Sabzwari R, Cao L, Ramanathan S, Hill JN, et al. Bacterial susceptibility patterns in patients with spinal cord injury and disorder (SCI/D): an opportunity for customized stewardship tools. Spinal Cord. 2016;54:1001–9.CrossRef Suda KJ, Patel UC, Sabzwari R, Cao L, Ramanathan S, Hill JN, et al. Bacterial susceptibility patterns in patients with spinal cord injury and disorder (SCI/D): an opportunity for customized stewardship tools. Spinal Cord. 2016;54:1001–9.CrossRef
18.
go back to reference Jernigan JA, Hatfield KM, Wolford H, Nelson RE, Olubajo B, Reddy SC, et al. Multidrug-resistant bacterial infections in U.S. hospitalized patients, 2012–2017. N Engl J Med. 2020;382:1309–19.CrossRef Jernigan JA, Hatfield KM, Wolford H, Nelson RE, Olubajo B, Reddy SC, et al. Multidrug-resistant bacterial infections in U.S. hospitalized patients, 2012–2017. N Engl J Med. 2020;382:1309–19.CrossRef
19.
go back to reference Sexton ME, Bower C, Sukumaran S, Jacob MT. Comparison of 30- and 90-day mortality rates in patients with cultures positive for carbapenem-resistant Enterobacteriaceae and Acinetobacter in Atlanta, 2011–2015. Open Forum Infect Dis. 2017;4:S44.CrossRef Sexton ME, Bower C, Sukumaran S, Jacob MT. Comparison of 30- and 90-day mortality rates in patients with cultures positive for carbapenem-resistant Enterobacteriaceae and Acinetobacter in Atlanta, 2011–2015. Open Forum Infect Dis. 2017;4:S44.CrossRef
20.
go back to reference Goto M, O’Shea AMJ, Livorsi DJ, McDanel JS, Jones MM, Richardson KK, Beck BF, et al. The effect of a nationwide infection control program expansion on hospital-onset Gram-negative rod bacteremia in 130 Veterans Health Administration Medical Centers: an interrupted time-series analysis. Clin Infect Dis. 2016;63(5):642–50.CrossRef Goto M, O’Shea AMJ, Livorsi DJ, McDanel JS, Jones MM, Richardson KK, Beck BF, et al. The effect of a nationwide infection control program expansion on hospital-onset Gram-negative rod bacteremia in 130 Veterans Health Administration Medical Centers: an interrupted time-series analysis. Clin Infect Dis. 2016;63(5):642–50.CrossRef
21.
go back to reference Rodriguez-Nunez O, Ripa M, Morata L, de la Calle C, Cardozo C, Fehér C, et al. Evaluation of ceftazidime/avibactam for serious infections due to multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa. J Glob Antimicrob Resist. 2018;15:136–9.CrossRef Rodriguez-Nunez O, Ripa M, Morata L, de la Calle C, Cardozo C, Fehér C, et al. Evaluation of ceftazidime/avibactam for serious infections due to multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa. J Glob Antimicrob Resist. 2018;15:136–9.CrossRef
22.
go back to reference Babiker A, Clarke LG, Saul M, Gealey JA, Clancy CJ, Nguyen MH, et al. Changing epidemiology and decreased mortality associated with carbapenem-resistant gram-negative bacteria, 2000–2017. Clin Infect Dis. 2020; ciaa1464. Babiker A, Clarke LG, Saul M, Gealey JA, Clancy CJ, Nguyen MH, et al. Changing epidemiology and decreased mortality associated with carbapenem-resistant gram-negative bacteria, 2000–2017. Clin Infect Dis. 2020; ciaa1464.
23.
go back to reference Son H, Cho EB, Bae M, Lee SC, Sung H, Kim MN, et al. Clinical and microbiological analysis of risk factors for mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia. Open Forum Infect Dis. 2020;7:ofaa378.CrossRef Son H, Cho EB, Bae M, Lee SC, Sung H, Kim MN, et al. Clinical and microbiological analysis of risk factors for mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia. Open Forum Infect Dis. 2020;7:ofaa378.CrossRef
24.
go back to reference Rannikko J, Syrjanen J, Seiskari T, Aittoniemi J, Huttunen R. Sepsis-related mortality in 497 cases with blood culture-positive sepsis in an emergency department. Int J Infect Dis. 2017;58:52–7.CrossRef Rannikko J, Syrjanen J, Seiskari T, Aittoniemi J, Huttunen R. Sepsis-related mortality in 497 cases with blood culture-positive sepsis in an emergency department. Int J Infect Dis. 2017;58:52–7.CrossRef
25.
go back to reference Jeong SJ, Yoon SS, Bae IK, Jeong SH, Kim JM, Lee K. Risk factors for mortality in patients with bloodstream infections caused by carbapenem resistant Pseudomonas aeruginosa: clinical impact of bacterial virulence and strains on outcome. Diagn Microbiol Infect Dis. 2014;80:130–5.CrossRef Jeong SJ, Yoon SS, Bae IK, Jeong SH, Kim JM, Lee K. Risk factors for mortality in patients with bloodstream infections caused by carbapenem resistant Pseudomonas aeruginosa: clinical impact of bacterial virulence and strains on outcome. Diagn Microbiol Infect Dis. 2014;80:130–5.CrossRef
27.
go back to reference Serra-Burriel M, Keys M, Campillo-Artero C, Agodi A, Barchitta M, Gikas A, et al. Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis. PLoS ONE. 2020;15(1): e0227139.CrossRef Serra-Burriel M, Keys M, Campillo-Artero C, Agodi A, Barchitta M, Gikas A, et al. Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis. PLoS ONE. 2020;15(1): e0227139.CrossRef
28.
go back to reference Montgomerie JZ, Chan E, Gilmore DS, Canawati HN, Sapico FL. Low mortality among patients with spinal cord injury and bacteremia. Rev Infect Dis. 1991;13:867–71.CrossRef Montgomerie JZ, Chan E, Gilmore DS, Canawati HN, Sapico FL. Low mortality among patients with spinal cord injury and bacteremia. Rev Infect Dis. 1991;13:867–71.CrossRef
29.
go back to reference Nucleo E, Caltagirone M, Marchetti VM, D’Angelo R, Fogato E, Confalonieri M, et al. Colonization of long-term care facility residents in three Italian Provinces by multidrug-resistant bacteria. Antimicrob Resist Infect Control. 2018;7:33.CrossRef Nucleo E, Caltagirone M, Marchetti VM, D’Angelo R, Fogato E, Confalonieri M, et al. Colonization of long-term care facility residents in three Italian Provinces by multidrug-resistant bacteria. Antimicrob Resist Infect Control. 2018;7:33.CrossRef
Metadata
Title
Epidemiology and outcomes associated with carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa: a retrospective cohort study
Authors
Amanda Vivo
Margaret A. Fitzpatrick
Katie J. Suda
Makoto M. Jones
Eli N. Perencevich
Michael A. Rubin
Swetha Ramanathan
Geneva M. Wilson
Martin E. Evans
Charlesnika T. Evans
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2022
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-022-07436-w

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