Abstract
BackgroundCarbapenem-resistant (CR) Acinetobacter baumannii is a concerning pathogen in the USA and worldwide.MethodsTo 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.Results2047 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.ConclusionsThese 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.
Highlights
Carbapenem-resistant (CR) Acinetobacter baumannii is a concerning pathogen in the USA and worldwide
Hospitalized adult patients were eligible for inclusion in the current analysis if they had isolation of A. baumannii at various infection sites during the study period, had microbiological susceptibility testing to the carbapenems performed, and received Gram-negative antibiotic treatment within the period of − 2 and + 3 days of the index culture to minimize the inclusion of potential colonizers (Fig. 1)
The median Charlson Comorbidity Index score of patients with CR and CS infections were equivalent (3 vs 3), higher scores were more frequent in patients with CR infections (Table 1)
Summary
Carbapenem-resistant (CR) Acinetobacter baumannii is a concerning pathogen in the USA and worldwide. The mortality rates in publications over the past two decades for patients with CR, MDR, or extensively drug-resistant A. baumannii infections have ranged between 24 and 83% globally, and patients with multiple comorbidities have a high risk of mortality due to CR A. baumannii infection [13, 14]. Despite these findings, contemporary data assessing the comparative burden of illness and impact on outcomes of infections due to CR versus carbapenem-susceptible (CS) infections remain limited
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
