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Epidemiology and clinical outcomes associated with extensively drug-resistant (XDR) Acinetobacter in US Veterans’ Affairs (VA) medical centers

Published online by Cambridge University Press:  30 September 2020

Margaret A. Fitzpatrick Open the ORCID record for Margaret A. Fitzpatrick [Opens in a new window] ,
Katie J. Suda ,
Linda Poggensee ,
Amanda Vivo ,
Marissa Wirth ,
Geneva Wilson ,
Martin Evans  and
Charlesnika T. Evans
Margaret A. Fitzpatrick*
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois Department of Medicine, Division of Infectious Diseases, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Katie J. Suda
Affiliation:
Department of Veterans’ Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Linda Poggensee
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois
Amanda Vivo
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois
Marissa Wirth
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois
Geneva Wilson
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois
Martin Evans
Affiliation:
VHA MRSA/MDRO Program Office, the National Infectious Diseases Service, Patient Care Services, VA Central Office and the Lexington VA Medical Center, Lexington, Kentucky
Charlesnika T. Evans
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois VHA MRSA/MDRO Program Office, the National Infectious Diseases Service, Patient Care Services, VA Central Office and the Lexington VA Medical Center, Lexington, Kentucky Department of Internal Medicine, University of Kentucky School of Medicine, Lexington, Kentucky Center for Health Services and Outcomes Research, Department of Preventive Medicine Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
*
Author for correspondence: Margaret A. Fitzpatrick, E-mail: Margaret.fitzpatrick@va.gov
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Abstract

Objective:

Although infections caused by Acinetobacter baumannii are often healthcare-acquired, difficult to treat, and associated with high mortality, epidemiologic data for this organism are limited. We describe the epidemiology, clinical characteristics, and outcomes for patients with extensively drug-resistant Acinetobacter baumannii (XDRAB).

Design:

Retrospective cohort study

Setting:

Department of Veterans’ Affairs Medical Centers (VAMCs)

Participants:

Patients with XDRAB cultures (defined as nonsusceptible to at least 1 agent in all but 2 or fewer classes) at VAMCs between 2012 and 2018.

Methods:

Microbiology and clinical data was extracted from national VA datasets. We used descriptive statistics to summarize patient characteristics and outcomes and bivariate analyses to compare outcomes by culture source.

Results:

Among 11,546 patients with 15,364 A. baumannii cultures, 408 (3.5%) patients had 667 (4.3%) XDRAB cultures. Patients with XDRAB were older (mean age, 68 years; SD, 12.2) with median Charlson index 3 (interquartile range, 1–5). Respiratory specimens (n = 244, 36.6%) and urine samples (n = 187, 28%) were the most frequent sources; the greatest proportion of patients were from the South (n = 162, 39.7%). Most patients had had antibiotic exposures (n = 362, 88.7%) and hospital or long-term care admissions (n = 331, 81%) in the prior 90 days. Polymyxins, tigecycline, and minocycline demonstrated the highest susceptibility. Also, 30-day mortality (n = 96, 23.5%) and 1-year mortality (n = 199, 48.8%) were high, with significantly higher mortality in patients with blood cultures.

Conclusions:

The proportion of Acinetobacter baumannii in the VA that was XDR was low, but treatment options are extremely limited and clinical outcomes were poor. Prevention of healthcare-associated XDRAB infection should remain a priority, and novel antibiotics for XDRAB treatment are urgently needed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 3 , March 2021 , pp. 305 - 310
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

ADDITIONAL PRESENTATION. These data were accepted as a poster presentation for the SHEA Decennial Conference 2020, presented in a supplementary publication.

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