Multidrug-Resistant Acinetobacter baumannii: An Emerging Pathogen among Older Adults in Community Hospitals and Nursing Homes
Multidrug-Resistant Acinetobacter baumannii: An Emerging Pathogen among Older Adults in Community Hospitals and Nursing Homes
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DOI：
10.1086/652759
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发表时间：
2010-06-15
影响因子：
11.8
通讯作者：
Kaye, K. S.
中科院分区：
文献类型：
--
作者：
Sengstock, D. M.;Thyagarajan, R.;Kaye, K. S.
背景。耐药不动杆菌在三级保健医院是一个问题。我们描述了社区医院老年不动杆菌感染的流行病学、耐药模式和结果。我们查询了Oakwood医疗保健系统（4家医院，床位分别为632、259、199和168张）2003-2008年的临床不动杆菌培养数据库。包括从家庭或养老院入院的年龄为bb0 = 60岁的患者。记录初始不动杆菌分离株及对8种抗生素的药敏情况。住院后48小时获得的培养物归类为“院内培养”。行政数据库提供了患者的来源（家庭或养老院）和出院目的地（家庭、养老院、长期急性护理机构、另一家医院、临终关怀或死亡）。在6年的时间里，560名社区居民（平均年龄+/-标准差，74 +/- 8.6岁）和280名养老院居民（78 +/- 9.1岁）分离出不动杆菌。在此期间，不动杆菌患病率增加了25% （P < 0.001，趋势检验）。2003年与2008年相比，不动杆菌对亚胺培南和氨苄西林/舒巴坦的耐药性增加（从1.8%增加到33.1%,P < 0.001），“全耐药”（即对所有8种抗生素的耐药性，从0.0%增加到13.6%,P < 0.001）。虽然社区获得性分离株的耐药性稳定（对类似的4.2种抗生素的耐药性），但疗养院获得性和医院获得性分离株的耐药性增加（分别从4.5到5.7和从5.0到6.0种抗生素，P < 0.01）。出院时，只有25%住在社区的病人和50%住在疗养院的病人返回原籍；其余患者需要更高水平的护理或死亡。在调整了年龄、住院时间和来源后，对每一种额外抗生素的耐药性预示着出院至更高护理水平或死亡的风险增加约20%（优势比为1.23；95%可信区间为1.11-1.36）。不动杆菌的流行率和耐药性在社区中呈上升趋势。具有耐药分离株的患者被选择性地送往疗养院和长期急症护理机构，从而对新设施产生耐药性。
Background. Drug-resistant Acinetobacter species are problematic in tertiary-care hospitals. We describe the epidemiology, resistance patterns, and outcomes of older adults with Acinetobacter infection in community hospitals.Methods. We queried the microbiology databases of the Oakwood Healthcare System (4 hospitals with 632, 259, 199, and 168 beds) for clinical Acinetobacter cultures obtained in 2003-2008. Patients aged >= 60 years who were admitted from home or nursing homes were included. We recorded the initial Acinetobacter isolate and susceptibility to 8 antibiotics. Cultures obtained 48 h after hospitalization were categorized as "nosocomial." Administrative databases provided patients' origins (home or nursing home) and discharge destinations (home, nursing home, long-term acute-care facility, another hospital, or hospice care or death).Results. During the 6-year period, 560 community-dwelling (mean age +/- standard deviation, 74 +/- 8.6 years) and 280 nursing home-dwelling (78 +/- 9.1 years) patients had Acinetobacter isolated. During this period, Acinetobacter prevalence increased 25% (P < .001, by trend test). In comparison of 2003 with 2008, Acinetobacter resistance to imipenem and ampicillin/sulbactam increased (from 1.8% to 33.1%; P < .001), as did "panresistance" (ie, resistance to all 8 antibiotics; increase from 0.0% to 13.6%; P < .001). Although resistance was stable in community-acquired isolates (resistance to similar to 4.2 antibiotics), resistance increased among nursing home-acquired and nosocomial-acquired isolates (from 4.5 to 5.7 and from 5.0 to 6.0 antibiotics, respectively; P < .01). At discharge, only 25% of community-dwelling and 50% of nursing home-dwelling patients returned to their place of origin; the remainder required higher levels of care or died. After adjustment for age, length of stay, and origin, resistance to each additional antibiotic predicted a >20% increased risk for discharge to higher levels of care or death (odds ratio, 1.23; 95% confidence interval, 1.11-1.36).Conclusions. The prevalence and resistance of Acinetobacter species are increasing in the community. Patients with resistant isolates are selectively discharged to nursing homes and long-term acute-care facilities, introducing resistance to new facilities.