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Clinical Outcomes of Carbapenem-Resistant Acinetobacter baumannii Bloodstream Infections: Study of a 2-State Monoclonal Outbreak

Published online by Cambridge University Press:  02 January 2015

L. Silvia Munoz-Price ,
Teresa Zembower ,
Sudhir Penugonda ,
Paul Schreckenberger ,
Mary Alice Lavin ,
Sharon Welbel ,
Dana Vais ,
Mirza Baig ,
Sunita Mohapatra  and
John P. Quinn
...Show all authors
L. Silvia Munoz-Price*
Affiliation:
University of Miami, Miami, Florida Jackson Memorial Hospital, Miami, Florida
Teresa Zembower
Affiliation:
Northwestern University Feinberg School of Medicine, Chicago, Illinois
Sudhir Penugonda
Affiliation:
Northwestern University Feinberg School of Medicine, Chicago, Illinois
Paul Schreckenberger
Affiliation:
Loyola University, Maywood, Chicago, Illinois
Mary Alice Lavin
Affiliation:
Rush University, Chicago, Illinois
Sharon Welbel
Affiliation:
John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
Dana Vais
Affiliation:
Rush University, Chicago, Illinois John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
Mirza Baig
Affiliation:
Mount Sinai Hospital, Chicago, Illinois
Sunita Mohapatra
Affiliation:
Mount Sinai Hospital, Chicago, Illinois
John P. Quinn
Affiliation:
Pfizer Global Research and Development, Groton, Connecticut
Robert A. Weinstein
Affiliation:
Rush University, Chicago, Illinois John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
*
Jackson Memorial Hospital, Park Plaza West L-302, 1611 NW 12th Avenue, Miami, FL 33136, ([email protected])
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Extract

Objective.

To characterize the clinical outcomes of patients with bloodstream infection caused by carbapenem-resistant Acinetobacter baumannii during a 2-state monoclonal outbreak.

Design.

Multicenter observational study.

Setting.

Four tertiary care hospitals and 1 long-term acute care hospital.

Methods.

A retrospective medical chart review was conducted for all consecutive patients during the period January 1, 2005, through April 30, 2006, for whom 1 or more blood cultures yielded carbapenem-resistant A. baumannii.

Results.

We identified 86 patients from the 16-month study period. Their mortality rate was 41%; of the 35 patients who died, one-third (13) had positive blood culture results for carbapenem-resistant A. baumannii at the time of death. Risk factors associated with mortality were intensive care unit stay, malignancy, and presence of fever and/or hypotension at the time blood sample for culture was obtained. Only 5 patients received adequate empirical antibiotic treatment, but the choice of treatment did not affect mortality.

Fifty-seven patients (66.2%) had a single positive blood culture result for carbapenem-resistant A. baumannii; the only factor associated with a single positive blood culture result was the presence of decubitus ulcers. Interestingly, during the study period, a transition from single to multiple positive blood culture results was observed. Four patients, 3 of whom were in a burn intensive care unit, were bacteremic for more than 30 days (range, 36–86 days).

Conclusions.

To our knowledge, this is the first time a study has described 2 patterns of bloodstream infection with A. baumannii: single versus multiple positive blood culture results, as well as a subset of patients with prolonged bacteremia.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 10 , October 2010 , pp. 1057 - 1062
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Munoz-Price, LS, Weinstein, RA. Acinetobacter infection. N Engl J Med 2008;358:1271–1281.CrossRefGoogle ScholarPubMed
2.Peleg, AY, Seifert, H, Paterson, DL. Acinetobacter baumannii; emergence of a successful pathogen. Clin Microbiol Rev 2008;21:538–582.CrossRefGoogle ScholarPubMed
3.Villegas, MV, Kattan, JN, Correa, A, et al.Dissemination of Acinetobacter baumannii clones with OXA-23 carbapenemase in Colombian hospitals. Antimicrob Agents Chemother 2007;51:2001–2004.Google Scholar
4.Coelho, JM, Turton, JF, Kaufmann, ME, et al.Occurrence of carbapenem-resistant Acinetobacter baumannii clones at multiple hospitals in London and southeast England. J Clin Microbiol 2006;44:3623–3627.Google Scholar
5.Park, YK, Peck, KR, Cheong, HS, Chung, DR, Song, JH, Ko, KS. Extreme drug resistance in Acinetobacter baumannii infections in intensive care units, South Korea. Emerg Infect Dis 2009;15:1325–1327.CrossRefGoogle ScholarPubMed
6.Naas, T, Coignard, B, Carbonne, A, et al.VEB-1 extended-spectrum β-lactamase-producing Acinetobacter baumannii, France. Emerg Infect Dis 2006;12:1214–1222.Google Scholar
7.Lolans, K, Rice, TW, Munoz-Price, LS, Quinn, JP. Multicity outbreak of carbapenem-resistant Acinetobacter baumannii isolates producing the carbapenemase OXA-40. Antimicrob Agents Chemother 2006;50:2941–2945.Google Scholar
8.Quale, J, Bratu, S, Landman, D, Heddurshetti, R. Molecular epidemiology and mechanisms of carbapenem resistance in Acinetobacter baumannii endemic in New York City. Clin Infect Dis 2003;37:214–220.CrossRefGoogle ScholarPubMed
9.Morgan, DJ, Weisenberg, SA, Augenbraun, MH, et al.Multidrug-resistant Acinetobacter baumannii in New York City—10 years into the epidemic. Infect Control Hosp Epidemiol 2009;30:196–197.CrossRefGoogle ScholarPubMed
10.Poirel, L, Nordmann, P. Carbapenem resistance in Acinetobacter baumannii: mechanisms and epidemiology. Clin Microbiol Infect 2006;12:826–836.Google Scholar
11.Beezhold, DW, Slaughter, S, Hayden, MK, et al.Skin colonization with vancomycin-resistant enterococci among hospitalized patients with bacteremia. Clin Infect Dis 1997;24:704–706.Google Scholar
12.Kwon, KT, Oh, WS, Song, JH, et al.Impact of imipenem resistance on mortality in patients with Acinetobacter bacteraemia. J Antimicrob Chemother 2007;59:525–530.Google Scholar
13.Jamulitrat, S, Arunpan, P, Phainuphong, P. Attributable mortality of im-ipenem-resistant nosocomial Acinetobacter baumannii bloodstream infection. J Med Assoc Thai 2009;92:413–419.Google ScholarPubMed
14.Tseng, YC, Wang, JT, Wu, FL, Chen, YC, Chie, WC, Chang, SC. Prognosis of adult patients with bacteremia caused by extensively resistant Acinetobacter baumannii. Diagn Microbiol Infect Dis 2007;59:181–190.CrossRefGoogle ScholarPubMed
15.Wareham, DW, Bean, DC, Khanna, P, et al.Bloodstream infection due to Acinetobacter spp: epidemiology, risk factors and impact of multidrug resistance. Eur J Clin Microbiol Infect Dis 2008;27:607–612.Google Scholar