Skip to main content

Advertisement

SpringerLink
Log in

Risk factors for and impact of carbapenem-resistant Acinetobacter baumannii colonization and infection: matched case–control study

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The objective of this investigation was to identify risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) and its association with mortality. A population-based matched case–control study using the computerized database of Clalit Health Services (CHS) in the period between 2007 and 2012 was conducted. Hospitalized patients with CRAB colonization or infection were compared to hospitalized patients without evidence of A. baumannii, matched by age, ward of hospitalization, season, Charlson score, and length of hospitalization. Risk factors for CRAB isolation were searched for using multivariate analysis. Association of CRAB and other risk factors with mortality were assessed in the cohort. A total of 1190 patients with CRAB were matched to 1190 patients without CRAB. Low socioeconomic status was independently associated with CRAB isolation and CRAB bacteremia [odds ratio 2.18, 95 % confidence interval (CI) 1.02–5]. Other risk factors were invasive procedures and bacteremia with other pathogens prior to CRAB isolation, and various comorbidities. Among all patients, CRAB isolation was independently associated with increased mortality (hazard ratio 2.33, 95 % CI 2.08–2.6). Socioeconomic status is associated with health outcomes. Our population-based study revealed an almost doubled risk for CRAB in patients at lower socioeconomic status and an association with healthcare exposure. CRAB was associated with mortality and might become a risk indicator for complex morbidity and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Villegas MV, Hartstein AI (2003) Acinetobacter outbreaks, 1977–2000. Infect Control Hosp Epidemiol 24(4):284–295

    Article  PubMed  Google Scholar 

  2. Dijkshoorn L, Nemec A, Seifert H (2007) An increasing threat in hospitals: multidrug-resistant Acinetobacter baumannii. Nat Rev Microbiol 5(12):939–951

    Article  CAS  PubMed  Google Scholar 

  3. Ruiz J, Núñez ML, Pérez J, Simarro E, Martínez-Campos L, Gómez J (1999) Evolution of resistance among clinical isolates of Acinetobacter over a 6-year period. Eur J Clin Microbiol Infect Dis 18(4):292–295

    Article  CAS  PubMed  Google Scholar 

  4. Agodi A, Voulgari E, Barchitta M, Quattrocchi A, Bellocchi P, Poulou A et al (2014) Spread of a carbapenem- and colistin-resistant Acinetobacter baumannii ST2 clonal strain causing outbreaks in two Sicilian hospitals. J Hosp Infect 86(4):260–266

    Article  CAS  PubMed  Google Scholar 

  5. Falagas ME, Kopterides P (2006) Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature. J Hosp Infect 64(1):7–15

    Article  CAS  PubMed  Google Scholar 

  6. Wadl M, Heckenbach K, Noll I, Ziesing S, Pfister W, Beer J et al (2010) Increasing occurrence of multidrug-resistance in Acinetobacter baumannii isolates from four German University Hospitals, 2002–2006. Infection 38(1):47–51

    Article  CAS  PubMed  Google Scholar 

  7. Abbo A, Carmeli Y, Navon-Venezia S, Siegman-Igra Y, Schwaber MJ (2007) Impact of multi-drug-resistant Acinetobacter baumannii on clinical outcomes. Eur J Clin Microbiol Infect Dis 26(11):793–800

    Article  CAS  PubMed  Google Scholar 

  8. Sunenshine RH, Wright MO, Maragakis LL, Harris AD, Song X, Hebden J et al (2007) Multidrug-resistant Acinetobacter infection mortality rate and length of hospitalization. Emerg Infect Dis 13(1):97–103

    Article  PubMed  PubMed Central  Google Scholar 

  9. del Mar Tomas M, Cartelle M, Pertega S, Beceiro A, Llinares P, Canle D et al (2005) Hospital outbreak caused by a carbapenem-resistant strain of Acinetobacter baumannii: patient prognosis and risk-factors for colonisation and infection. Clin Microbiol Infect 11(7):540–546

    Article  PubMed  Google Scholar 

  10. Lee SO, Kim NJ, Choi SH, Hyong Kim T, Chung JW, Woo JH et al (2004) Risk factors for acquisition of imipenem-resistant Acinetobacter baumannii: a case–control study. Antimicrob Agents Chemother 48(1):224–228

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Playford EG, Craig JC, Iredell JR (2007) Carbapenem-resistant Acinetobacter baumannii in intensive care unit patients: risk factors for acquisition, infection and their consequences. J Hosp Infect 65(3):204–211

    Article  CAS  PubMed  Google Scholar 

  12. Corbella X, Montero A, Pujol M, Domínguez MA, Ayats J, Argerich MJ et al (2000) Emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multiresistant Acinetobacter baumannii. J Clin Microbiol 38(11):4086–4095

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Tacconelli E, Cataldo MA, De Pascale G, Manno D, Spanu T, Cambieri A et al (2008) Prediction models to identify hospitalized patients at risk of being colonized or infected with multidrug-resistant Acinetobacter baumannii calcoaceticus complex. J Antimicrob Chemother 62(5):1130–1137

    Article  CAS  PubMed  Google Scholar 

  14. Routsi C, Pratikaki M, Platsouka E, Sotiropoulou C, Nanas S, Markaki V et al (2010) Carbapenem-resistant versus carbapenem-susceptible Acinetobacter baumannii bacteremia in a Greek intensive care unit: risk factors, clinical features and outcomes. Infection 38(3):173–180

    Article  CAS  PubMed  Google Scholar 

  15. Levin AS, Mendes CM, Sinto SI, Sader HS, Scarpitta CR, Rodrigues E et al (1996) An outbreak of multiresistant Acinetobacter baumanii in a university hospital in São Paulo, Brazil. Infect Control Hosp Epidemiol 17(6):366–368

    Article  CAS  PubMed  Google Scholar 

  16. Falagas ME, Bliziotis IA, Siempos II (2006) Attributable mortality of Acinetobacter baumannii infections in critically ill patients: a systematic review of matched cohort and case–control studies. Crit Care 10(2):R48

    Article  PubMed  PubMed Central  Google Scholar 

  17. Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36(5):309–332

    Article  PubMed  Google Scholar 

  18. Villar M, Cano ME, Gato E, Garnacho-Montero J, Miguel Cisneros J, Ruíz de Alegría C et al (2014) Epidemiologic and clinical impact of Acinetobacter baumannii colonization and infection: a reappraisal. Medicine 93(5):202–210

    Article  PubMed  Google Scholar 

  19. Bonelli RR, Moreira BM, Picão RC (2014) Antimicrobial resistance among Enterobacteriaceae in South America: history, current dissemination status and associated socioeconomic factors. Drug Resist Updat 17(1–2):24–36

    Article  PubMed  Google Scholar 

  20. Kristiansson C, Grape M, Gotuzzo E, Samalvides F, Chauca J, Larsson M et al (2009) Socioeconomic factors and antibiotic use in relation to antimicrobial resistance in the Amazonian area of Peru. Scand J Infect Dis 41(4):303–312

    Article  CAS  PubMed  Google Scholar 

  21. Kirby A, Herbert A (2013) Correlations between income inequality and antimicrobial resistance. PLoS One 8(8):e73115

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Mackall C, Fry T, Gress R, Peggs K, Storek J, Toubert A (2009) Background to hematopoietic cell transplantation, including post transplant immune recovery. Bone Marrow Transplant 44(8):457–462

    Article  CAS  PubMed  Google Scholar 

  23. Lautenbach E, Synnestvedt M, Weiner MG, Bilker WB, Vo L, Schein J et al (2009) Epidemiology and impact of imipenem resistance in Acinetobacter baumannii. Infect Control Hosp Epidemiol 30(12):1186–1192

    Article  PubMed  Google Scholar 

  24. Harris AD, Karchmer TB, Carmeli Y, Samore MH (2001) Methodological principles of case–control studies that analyzed risk factors for antibiotic resistance: a systematic review. Clin Infect Dis 32(7):1055–1061

    Article  CAS  PubMed  Google Scholar 

  25. Harris AD, Samore MH, Lipsitch M, Kaye KS, Perencevich E, Carmeli Y (2002) Control-group selection importance in studies of antimicrobial resistance: examples applied to Pseudomonas aeruginosa, Enterococci, and Escherichia coli. Clin Infect Dis 34(12):1558–1563

    Article  PubMed  Google Scholar 

Download references

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Conflict of interest

All authors have no conflicts of interest relevant to this article to disclose.

Author information

Authors and Affiliations

  1. Infectious Disease Unit, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel

    O. Henig & G. Weber

  2. Clalit Research Institute, Chief Physician’s Office, Clalit Health Services, Tel Aviv, Israel

    O. Henig, M. B. Hoshen, L. German, I. Gluzman, A. Berlin & R. D. Balicer

  3. Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel

    M. Paul & A. Neuberger

  4. Technion Faculty of Medicine, Haifa, Israel

    G. Weber, A. Neuberger & C. Shapira

  5. Lady Davis Carmel Medical Center, Haifa, Israel

    C. Shapira

  6. Public Health Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

    R. D. Balicer

Authors
  1. O. Henig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. B. Hoshen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L. German
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Neuberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. I. Gluzman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Berlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C. Shapira
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. R. D. Balicer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O. Henig.

Additional information

Larissa German is a Research Consultant, Calgary, Alberta, Canada.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Henig, O., Weber, G., Hoshen, M.B. et al. Risk factors for and impact of carbapenem-resistant Acinetobacter baumannii colonization and infection: matched case–control study. Eur J Clin Microbiol Infect Dis 34, 2063–2068 (2015). https://doi.org/10.1007/s10096-015-2452-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-015-2452-4

Keywords

Search

Navigation