Risk factors for healthcare-associated extensively drug-resistant Acinetobacter baumannii infections: A case-control study
Journal
PLoS ONE
Journal Volume
9
Journal Issue
1
Date Issued
2014
Author(s)
Abstract
The emergence of extensively drug-resistant Acinetobacter baumannii (XDRAB) is a serious threat to hospitalized patients. From 2008 to 2010, surveillance detected 25 hospital-acquired infection (HAI) cases caused by XDRAB at a medical center in Taipei. The site of XDRAB infection was bloodstream (n = 8), urinary tract (n = 12), lower respiratory tract (n = 3), surgical site (n = 1), and cardiovascular (n = 1). The isolates were resistant to all currently available antibiotics except for colistin. The XDRAB isolates are genetically diverse, shown by pulsed-field gel electrophoresis, but 23 of 25 harbored class 1 integron with a 2.3-kb gene cassette. Most of these isolates carry OXA-23 (n = 21) and OXA-51-like carbapenemase genes (n = 25). To identify the risk factors, a case-control study was conducted. The 25 cases were compared with 100 controls randomly selected from hospitalized patients without XDRAB-HAIs, matched by the onset date, ward, and age, at a ratio of 1:4. Prior use of imipenem, meropenem, piperacillin/tazobactam or fourth-generation cephalosporins (adjusted OR: 3.2, 95% CI: 1.03-10.2, P = 0.04) and >30 days bed-ridden (adjusted OR: 6.0, 95% CI: 1.3-27.6, P = 0.02) were found to be the independent risk factors for XDRAB-HAIs. These findings highlight that, even in the absence of clonal dissemination, XDRAB can emerge under the selective pressure of broad-spectrum antibiotics and causes subsequent HAIs in compromised hosts. An appropriate response to the XDRAB threat therefore should include a component of prudent use of broad-spectrum antibiotics active against gram-negative bacteria. ? 2014 Chan et al.
SDGs
Other Subjects
carbapenemase; cephalosporin derivative; imipenem; meropenem; piperacillin plus tazobactam; Acinetobacter baumannii; Acinetobacter infection; aged; antibiotic resistance; article; bacterial gene; bacterium identification; bacterium isolation; carbapenemase gene; case control study; clinical article; controlled study; disease association; female; gene function; gene identification; human; infection risk; integron; male; nonhuman; outcome assessment; risk assessment; risk factor; Acinetobacter baumannii; Acinetobacter Infections; Aged; Anti-Infective Agents; Bacterial Proteins; Bacterial Typing Techniques; beta-Lactamases; Case-Control Studies; Cross Infection; Delivery of Health Care; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Genes, Bacterial; Humans; Integrons; Male; Microbial Sensitivity Tests; Multivariate Analysis; Risk Factors; Taiwan
Publisher
Public Library of Science
Type
journal article