Epidemiology and clinical outcomes associated with extensively drug-resistant (XDR) Acinetobacter in US Veterans' Affairs (VA) medical centers.
Epidemiology and clinical outcomes associated with extensively drug-resistant (XDR) Acinetobacter in US Veterans' Affairs (VA) medical centers.
复制标题
DOI：
10.1017/ice.2020.450
复制
发表时间：
2021-03
影响因子：
4.5
通讯作者：
Evans CT
中科院分区：
文献类型：
--
作者：
Fitzpatrick MA;Suda KJ;Poggensee L;Vivo A;Wirth M;Wilson G;Evans M;Evans CT
虽然鲍曼不动杆菌（AB）引起的感染通常是医疗获得性的，难以治疗，并与高死亡率相关，但这种微生物的流行病学数据有限。本研究的目的是描述XDRAB患者的流行病学、临床特征和结局。回顾性队列研究退伍军人事务部医疗中心（VAMC）2012年至2018年期间在VAMC接受XDRAB培养的患者（定义为除2个或更少类别外，对所有类别中的至少1种药物不敏感）。从国家VA数据集中提取微生物学和临床数据。描述性统计总结了患者特征和结局，双变量分析比较了不同文化来源的结局。在11,546例患者中，15,364例A.鲍曼不动杆菌培养，408例（3.5%）患者有667例（4.3%）XDRAB培养。XDRAB患者年龄较大[平均年龄（SD）=68（12.2）岁]，中位（IQR）Charlson指数3（1-5）。呼吸道（n=244，36.6%）和尿液（n=187，28%）是最常见的来源;最大比例的患者来自南方（n=162，39.7%）。大多数患者在前90天内有抗生素暴露（n=362，88.7%）和住院或长期护理入院（n=331，81%）。多粘菌素、替加环素和米诺环素表现出最高的敏感性。30-日（n=96，23.5%）和1年（n=199，48.8%）死亡率较高，血培养患者的死亡率显著较高。VA中AB型XDR的比例较低，但治疗选择极其有限，临床结局较差。预防医疗保健相关的XDRAB感染应仍然是一个优先事项，并迫切需要用于XDRAB治疗的新型抗生素。
Although infections caused by Acinetobacter baumannii (AB) are often healthcare-acquired, difficult to treat, and associated with high mortality, epidemiologic data for this organism are limited. This study’s aim was to describe epidemiology, clinical characteristics, and outcomes for patients with XDRAB. Retrospective cohort study Department of Veterans Affairs Medical Centers (VAMCs) Patients with XDRAB cultures (defined as non-susceptible to at least 1 agent in all but 2 or fewer classes) at VAMCs between 2012–2018. Microbiology and clinical data was extracted from national VA datasets. Descriptive statistics summarized patient characteristics and outcomes, and bivariate analyses compared outcomes by culture source. Among 11,546 patients with 15,364 A. baumannii cultures, 408 (3.5%) patients had 667 (4.3%) XDRAB cultures. Patients with XDRAB were older [mean age (SD)=68 (12.2) years] with median (IQR) Charlson index 3 (1–5). Respiratory (n=244, 36.6%) and urine (n=187, 28%) were the most frequent sources; the greatest proportion of patients were from the South (n=162, 39.7%). Most patients had antibiotic exposures (n=362, 88.7%) and hospital or long-term care admissions (n=331, 81%) in the prior 90 days. Polymyxins, tigecycline, and minocycline demonstrated the highest susceptibility. 30-day (n=96, 23.5%) and one-year (n=199, 48.8%) mortality were high, with significantly higher mortality in patients with blood cultures. The proportion of AB in the VA that was XDR was low, but treatment options were extremely limited and clinical outcomes were poor. Prevention of healthcare associated XDRAB infection should remain a priority, and novel antibiotics for XDRAB treatment are urgently needed.
登录
查看更多内容
影响因子：
4.9
作者：
Ramanathan S;Suda KJ;Fitzpatrick MA;Poggensee L;LaVela SL;Burns SP;Evans CT
通讯作者：
Evans CT
影响因子：
1.6
作者：
Jean SS;Hsieh TC;Lee WS;Hsueh PR;Hsu CW;Lam C
通讯作者：
Lam C
影响因子：
14.2
作者：
Magiorakos, A. -P.;Srinivasan, A.;Monnet, D. L.
通讯作者：
Monnet, D. L.
影响因子：
4.5
作者：
Nelson, Richard E.;Schweizer, Marin L.;Samore, Matthew H.
通讯作者：
Samore, Matthew H.
影响因子：
4.5
作者：
Weiner LM;Webb AK;Limbago B;Dudeck MA;Patel J;Kallen AJ;Edwards JR;Sievert DM
通讯作者：
Sievert DM