385. Carbapenem-resistant Acinetobacter (CRA): Epidemiology and risk factors in tertiary care center
Session: Poster Abstract Session: Gram Negative Infection - Epidemiology and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • Presentation1.pdf (125.3 kB)
  • Background:  Studies worldwide have suggested multiple risk factors, clinical characteristics and outcomes of infection with CRA. The purpose of this study was to describe our experience with these organisms in a tertiary care center.

    Methods: We performed a retrospective analysis of clinical characteristics and outcomes of patients with CRA infections from January 2009 to January 2011.  Additionally, we performed an age/sex-matched case-control study, comparing patients with carbapenem-resistant and sensitive Acinetobacter infections.

    Results: We identified 66 cases of CRA and 76 controls. Demographics, comorbidities, line days and ventilator days were similar between the two groups. Mean±SD Hospital length of stay in days was 37±27 for CRA vs. 28±28 for controls (p=0.03).   CRA cases were most frequently considered hospital-acquired (59%) and occurred in the ICU (73%). The majority of CRA species were A. baumannii (65%) and organisms were most frequently isolated from respiratory sources (52%) or blood (17%). Other significant clinical characteristics and outcomes are shown in the table. CRA cases were treated with amikacin (9%), colistin (61%), minocycline (12%), and tigecycline (24%). While there was a higher risk of relapse, there were no significant differences in microbiological persistence or all cause mortality.

    Conclusion: CRA appears to be associated with recent exposure to both acute and long term healthcare facilities, as well as a longer hospital length of stay. CRA patients were more likely to have a history of previous antibiotic use. CRA had a higher risk of relapse, but in this study it was not associated with increased all cause mortality.

    Variable

    Cases (n=66)

    Controls (n=76)

    OR (95%CI)

    Any hospital admission within 3 months (%)

    72

    32

    5.7 (2.8-11.8)

    Any long term care facility within 3 months (%)

    35

    7

    3.4 (1.1-10.4)

    Antibiotic exposure within 14 days (%)

    82

    61

    2.9 (1.3-6.3)

    Antibiotic exposure within 30 days (%)

    44

    18

    3.4 (1.6-7.3)

    Antibiotic exposure within 90 days (%)

    30

    12

    3.2 (1.3-7.6)

    Relapse within 30 days (%)

    13

    1

    11.8 (1.8-73.85)

    All cause mortality (%)

    21

    15

    NS

     


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Madiha Ashraf, MD1, Audrey Wanger, PhD2, Enuo Chen1 and Luis Ostrosky-Zeichner, MD, FIDSA1, (1)Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, TX, (2)Department of Pathology, University of Texas Medical School at Houston, Houston, TX

    Disclosures:

    M. Ashraf, None

    A. Wanger, None

    E. Chen, None

    L. Ostrosky-Zeichner, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.