Carbapenem-Nonsusceptible Acinetobacter Baumannii

8 US Metropolitan Areas, 2012-2015

Sandra N. Bulens; Sarah H. Yi; Maroya S. Walters; Jesse T. Jacob; Chris Bower; Jessica Reno; Lucy Wilson; Elisabeth Vaeth; Wendy Bamberg; Sarah J. Janelle; Ruth Lynfield; Paula Snippes Vagnone; Kristin Shaw; Marion Kainer; Daniel Muleta; Jacqueline Mounsey; Ghinwa Dumyati; Cathleen Concannon; Zintars Beldavs; P. Maureen Cassidy; Erin C. Phipps; Nicole Kenslow; Emily B. Hancock; Alexander J. Kallen

Disclosures

Emerging Infectious Diseases. 2018;24(4):727-734. 

In This Article

Abstract and Introduction

Abstract

In healthcare settings, Acinetobacter spp. bacteria commonly demonstrate antimicrobial resistance, making them a major treatment challenge. Nearly half of Acinetobacter organisms from clinical cultures in the United States are nonsusceptible to carbapenem antimicrobial drugs. During 2012–2015, we conducted laboratory- and population-based surveillance in selected metropolitan areas in Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee to determine the incidence of carbapenem-nonsusceptible A. baumannii cultured from urine or normally sterile sites and to describe the demographic and clinical characteristics of patients and cases. We identified 621 cases in 537 patients; crude annual incidence was 1.2 cases/100,000 persons. Among 598 cases for which complete data were available, 528 (88.3%) occurred among patients with exposure to a healthcare facility during the preceding year; 506 (84.6%) patients had an indwelling device. Although incidence was lower than for other healthcare-associated pathogens, cases were associated with substantial illness and death.

Introduction

The bacterium Acinetobacter baumannii is a recognized cause of healthcare-associated illness, including pneumonia, bacteremia, and urinary tract infections (UTIs).[1–3]Acinetobacter isolates often demonstrate resistance to multiple classes of antimicrobial drugs, leading to treatment challenges. A Centers for Disease Control and Prevention (CDC) report, Antimicrobial Resistance Threats in the United States, 2013, highlighted multidrug-resistant Acinetobacter as a serious threat that causes ≈7,000 infections and ≈500 deaths in the United States each year.[4]

Carbapenems are often used to treat multidrug-resistant bacterial infections, such as those caused by Acinetobacter spp. Nearly half of Acinetobacter strains isolated from persons with healthcare-associated infections reported to the CDC National Healthcare Safety Network in 2014 were carbapenem-nonsusceptible.[5] Infections with carbapenem-resistant A. baumannii have been associated with death rates as high as 52%.[6–10]

Preventing the transmission of resistant organisms, including carbapenem-resistant A. baumannii, is a major public health priority.[11] To identify opportunities for prevention, the Emerging Infections Program (EIP) conducts population- and laboratory-based surveillance for carbapenem-nonsusceptible A. baumannii in 8 US metropolitan areas through its Multi-site Gram-negative Surveillance Initiative (MuGSI). Our objective was to describe the epidemiology and estimate the crude population-based incidence of carbapenem-nonsusceptible A. baumannii during the first 4 years of surveillance.

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