Risk factors for hospital-acquired antimicrobial-resistant infection caused by Acinetobacter baumannii

Abstract

BACKGROUND: Acinetobacter baumannii can cause serious healthcare-associated infections (HAIs) and the incidence is increasing, with many strains now resistant to multiple antibiotic classes. The aims of this study were to examine factors associated with HAIs caused by antimicrobial-resistant as compared with antimicrobial-susceptible strains of A. baumannii and to investigate trends in the incidence of resistance over time. Electronic data from two U.S. hospitals in a large urban healthcare system in over the years 2006-2012 were used for the analysis. Multiple logistic regression was used to explore risk factors for infection with A. baumannii resistant to ampicillin or ampicillin/sulbactam in the bloodstream, urinary tract, and respiratory tract. The Cochran-Armitage trend test was used to explore resistance trends over time. FINDINGS: A total of 671 adults with first-time A. baumannii infection were included in the analysis; 302 isolates (45 %) were resistant to ampicillin or ampicillin/sulbactam and 369 (55 %) were susceptible. In the multivariable analysis, significant risk factors included longer length of stay prior to infection (Odds Ratio [OR] = 1.03; 95 % Confidence Interval [CI]: 1.01, 1.04), hospital A versus B (OR = 0.35; 95 % CI: 0.13, 0.93), and antibiotic use prior to infection (OR = 2.88; 95 % CI: 1.02, 8.13). Resistance was more common in respiratory infections (OR = 2.96; 95 % CI: 1.04, 8.44). No trend was found between year of infection and resistance. CONCLUSIONS: The risk factors we identified are consistent with previous findings, but we found no evidence in this population that resistance to ampicillin or ampicillin/sulbactam was increasing over time.