Risk factors for acquisition of multidrug-resistant Acinetobacter baumannii among cancer patients

Fukuta, Yuriko; Muder, Robert R.; Agha, Mounzer; Clarke, Lloyd; Wagener, Marilyn M.; Hensler, Amelia; Doi, Yohei

doi:10.1016/j.ajic.2013.04.003

Cited by 43 publications

(35 citation statements)

References 26 publications

(28 reference statements)

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“…This finding was not unexpected, owing to the fact that chemotherapy compromises the host immune system, thus making patients highly vulnerable for opportunistic nosocomial infections such as ABC. Fukuta et al reported that acquisition of MDR A. baumannii infections in cancer patients was not directly related to immunosuppressive therapy and might be attributed to the severity of the underlying illness and the extensive health care exposures associated with their primary condition (28).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Outcomes for Patients with Bloodstream Infection Due to Acinetobacter baumannii-calcoaceticus Complex

Chopra

Marchaim

Johnson

et al. 2014

Antimicrob Agents Chemother

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bIdentifying patients at risk for bloodstream infection (BSI) due to Acinetobacter baumannii-Acinetobacter calcoaceticus complex (ABC) and providing early appropriate therapy are critical for improving patient outcomes. A retrospective matched casecontrol study was conducted to investigate the risk factors for BSI due to ABC in patients admitted to the Detroit Medical Center (DMC) between January 2006 and April 2009. The cases were patients with BSI due to ABC; the controls were patients not infected with ABC. Potential risk factors were collected 30 days prior to the ABC-positive culture date for the cases and 30 days prior to admission for the controls. A total of 245 case patients were matched with 245 control patients. Independent risk factors associated with BSI due to ABC included a Charlson's comorbidity score of >3 (odds ratio [OR], 2.34; P ‫؍‬ 0.001), a direct admission from another health care facility (OR, 4.63; P < 0.0001), a prior hospitalization (OR, 3.11; P < 0.0001), the presence of an indwelling central venous line (OR, 2.75; P ‫؍‬ 0.011), the receipt of total parenteral nutrition (OR, 21.2; P < 0.0001), the prior receipt of ␤-lactams (OR, 3.58; P < 0.0001), the prior receipt of carbapenems (OR, 3.18; P ‫؍‬ 0.006), and the prior receipt of chemotherapy (OR, 15.42; P < 0.0001). The median time from the ABC-positive culture date to the initiation of the appropriate antimicrobial therapy was 2 days (interquartile range [IQR], 1 to 3 days). The in-hospital mortality rate was significantly higher among case patients than among control patients (OR, 3.40; P < 0.0001). BSIs due to ABC are more common among critically ill and debilitated institutionalized patients, who are heavily exposed to health care settings and invasive devices.

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Section: Discussionmentioning

confidence: 99%

Risk Factors and Outcomes for Patients with Bloodstream Infection Due to Acinetobacter baumannii-calcoaceticus Complex

Chopra

Marchaim

Johnson

et al. 2014

Antimicrob Agents Chemother

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Section: Introductionmentioning

confidence: 99%

“…According to a recent survey by the Centers for Disease Control and Prevention (CDC), one in 25 hospitalized patients [4.0 %; 95 % confidence interval (CI 95 % ), 3.7-4.4] is battling an HAI, defined as those infections acquired in hospital or healthcare service unit that first appear 48 h or more after hospital admission or within 30 days after discharge following in-patient care (Revelas, 2012;Magill et al, 2014). Other causes for concern in many healthcare centres for patients with cancer are the high bacterial resistance rates and the rise of opportunistic multidrug-resistant (MDR) pathogens such as Pseudomonas aeruginosa and Acinetobacter baumannii (Pongas et al, 2012;Fukuta et al, 2013;Marín et al, 2014).Gram-positive bacteria are described as the most frequent cause of HAIs in cancer patients, especially through bloodstream infection (Wisplinghoff et al, 2003;Maschmeyer & Haas, 2008;Wang et al, 2011; Kosmidis & Chandrasekar, 2012), although in recent years a change in the epidemiology of infections in this group of patients has been observed, with an increase in infections caused by Gram-negative bacteria, and increased antibiotic resistance in this group of bacteria (Bassetti & Righi, 2013;Gudiol et al, 2010;Montassier et al, 2013;Marín et al, 2014). The Gram-negative bacteria most frequently isolated in cancer patients are the Enterobacteriaceae Escherichia coli and Klebsiella spp., followed by the glucose non-fermenting bacilli P. aeruginosa, Acinetobacter spp.…”

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confidence: 99%

Detection of bla SPM-1, bla KPC, bla TEM and bla CTX-M genes in isolates of Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. from cancer patients with healthcare-associated infections

Jácome

Alves

Jácome-Júnior

et al. 2016

Journal of Medical Microbiology

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Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. are three of the pathogens most frequently involved in infections of cancer patients, and the production of b-lactamases is a major mechanism of resistance due to its wide diversity of existing enzymes. Therefore, the aim of the present study was to investigate the microbiological profile and data related to patients and infections, and to search for b-lactamase genes in bacterial isolates from hospitalized cancer patients in a hospital in Recife, Pernambuco, Brazil. A total of 169 isolates were recovered between 2012 and 2014, of which 58 were P. aeruginosa, 36 were Acinetobacter spp. and 75 were Klebsiella spp. A high percentage of carbapenem resistance was observed in P. aeruginosa and Acinetobacter spp. Among the carbapenem-resistant bacteria, the bla SPM-1 gene was detected in P. aeruginosa (35.5 %) and Acinetobacter spp. (3.8 %), while bla KPC was detected in P. aeruginosa (25.8 %) only. Among the third-and fourth-generation cephalosporin-resistant strains, in Klebsiella spp. we detected the genes bla TEM (30.6 %), bla CTX-M (58.3 %) and bla KPC (5.6 %), and in Acinetobacter spp. only bla TEM (25.9 %). This the first report of an Acinetobacter baumannii bla SPM-1 gene carrier that has been isolated in Brazil. The most frequent cancer types were bowel tumour [14.8 %; 95 % confidence interval (CI 95 % ) 9.8-21.1 %], breast cancer (13.6 %; CI 95 % 8.8-19.7 %) and prostate cancer (11.2%; CI 95 % 6.9-17.0 %). These results therefore provide knowledge of susceptibility profile and resistance mechanisms and thus can contribute to the strategic formulation of hospital infection control plans and the rational use of antimicrobials, reducing mortality from infection levels in cancer patients. frequency and severity of infections may be related to the use of potent cytotoxic drugs and increasingly invasive diagnostic tools (Maschmeyer & Haas, 2008;Wang et al., 2011). INTRODUCTIONGiven this vulnerability among patients with cancer, this population is more susceptible to community and healthcare-associated infections (HAIs). According to a recent survey by the Centers for Disease Control and Prevention (CDC), one in 25 hospitalized patients [4.0 %; 95 % confidence interval (CI 95 % ), 3.7-4.4] is battling an HAI, defined as those infections acquired in hospital or healthcare service unit that first appear 48 h or more after hospital admission or within 30 days after discharge following in-patient care (Revelas, 2012;Magill et al., 2014). Other causes for concern in many healthcare centres for patients with cancer are the high bacterial resistance rates and the rise of opportunistic multidrug-resistant (MDR) pathogens such as Pseudomonas aeruginosa and Acinetobacter baumannii (Pongas et al., 2012;Fukuta et al., 2013;Marín et al., 2014).Gram-positive bacteria are described as the most frequent cause of HAIs in cancer patients, especially through bloodstream infection (Wisplinghoff et al., 2003;Maschmeyer & Haas, 2008;Wang et al., 2011; Kosmidis & Chandrasekar...

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“…Furthermore, the presence of five or more risk factors is significantly associated with increase in drug resistance. Fukuta et al and Surasarang et al in their individual studies found mechanical ventilation, prolonged intensive unit care stay and prior antimicrobial use to be significant risk factors for acquisition of infection due to MDR Acinetobacter isolates [22,23]. Pertaining solely to the ICU settings, the risk factors that significantly lead to increase in drug resistance were found out to be mechanical ventilation, endotracheal intubation, post-operative cases and COPD and CKD.…”

Section: Khurana Et Almentioning

confidence: 99%

A Rising Threat – Risk Factors and Outcomes Related to Infections With Acinetobacter Species

Khurana¹,

Baliga

Shenoy

et al. 2017

Asian J Pharm Clin Res

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Objective: Acinetobacter species is an important cause of community as well as nosocomial infections with a high mortality rate. The study was done to analyze the risk factors associated with Acinetobacter infections and their outcomes. Methods:The clinical details of 100 patients having infections with Acinetobacter species over a period of 1-year were analyzed for underlying risk factors and outcomes. The antibiotic sensitivity results were interpreted according to the Clinical Laboratory Standards Institute guidelines.Results: Majority of the infections caused by the Acinetobacter species were lower respiratory tract infections, most common being ventilatorassociated pneumonia. 47% of the isolates were multi drug resistant and 26% were extensively drug resistant. There is a significant chance of drug resistance and a poor outcome with intensive care unit (ICU) stay, prolonged hospital stay of more than 7 days, the presence of 5 or more risk factors. Endotracheal intubation and mechanical ventilation were the risk factors for increased drug resistance in the ICU. Drug resistance was also seen more frequently in patients with chronic obstructive pulmonary disease, chronic kidney disease, and patients on post-operative care. Conclusion:The steady increase in drug resistant Acinetobacter species and limited antibiotics available advocates an uncompromising approach toward infection control and a judicious use of antibiotics especially in the ICU. An understanding about the risk factors helps in the appropriate approach and management of the patient.

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Risk factors for acquisition of multidrug-resistant Acinetobacter baumannii among cancer patients

Cited by 43 publications

References 26 publications

Risk Factors and Outcomes for Patients with Bloodstream Infection Due to Acinetobacter baumannii-calcoaceticus Complex

Risk Factors and Outcomes for Patients with Bloodstream Infection Due to Acinetobacter baumannii-calcoaceticus Complex

Detection of bla SPM-1, bla KPC, bla TEM and bla CTX-M genes in isolates of Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. from cancer patients with healthcare-associated infections

A Rising Threat – Risk Factors and Outcomes Related to Infections With Acinetobacter Species

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