与美国退伍军人事务部 (VA) 医疗中心广泛耐药 (XDR) 相关的流行病学和临床结局。
Epidemiology and clinical outcomes associated with extensively drug-resistant (XDR) in US Veterans' Affairs (VA) medical centers.
机构信息
Department of Veterans' Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois.
Department of Medicine, Division of Infectious Diseases, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.
出版信息
Infect Control Hosp Epidemiol. 2021 Mar;42(3):305-310. doi: 10.1017/ice.2020.450. Epub 2020 Sep 30.
OBJECTIVE
Although infections caused by Acinetobacter baumannii are often healthcare-acquired, difficult to treat, and associated with high mortality, epidemiologic data for this organism are limited. We describe the epidemiology, clinical characteristics, and outcomes for patients with extensively drug-resistant Acinetobacter baumannii (XDRAB).
DESIGN
Retrospective cohort study.
SETTING
Department of Veterans' Affairs Medical Centers (VAMCs).
PARTICIPANTS
Patients with XDRAB cultures (defined as nonsusceptible to at least 1 agent in all but 2 or fewer classes) at VAMCs between 2012 and 2018.
METHODS
Microbiology and clinical data was extracted from national VA datasets. We used descriptive statistics to summarize patient characteristics and outcomes and bivariate analyses to compare outcomes by culture source.
RESULTS
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, 68 years; SD, 12.2) with median Charlson index 3 (interquartile range, 1-5). Respiratory specimens (n = 244, 36.6%) and urine samples (n = 187, 28%) were the most frequent sources; the greatest proportion of patients were from the South (n = 162, 39.7%). Most patients had 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. Also, 30-day mortality (n = 96, 23.5%) and 1-year mortality (n = 199, 48.8%) were high, with significantly higher mortality in patients with blood cultures.
CONCLUSIONS
The proportion of Acinetobacter baumannii in the VA that was XDR was low, but treatment options are 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.
目的
虽然鲍曼不动杆菌引起的感染通常是医院获得性的、难以治疗的，并与高死亡率相关，但关于该病原体的流行病学数据有限。我们描述了广泛耐药鲍曼不动杆菌（XDRAB）患者的流行病学、临床特征和结局。
设计
回顾性队列研究。
地点
退伍军人事务部医疗中心（VAMC）。
参与者
2012 年至 2018 年间在 VAMC 进行 XDRAB 培养的患者（定义为对除 2 种或更少类别中的至少 1 种药物不敏感）。
方法
从国家退伍军人事务部数据集提取微生物学和临床数据。我们使用描述性统计来总结患者特征和结局，并进行双变量分析比较不同培养源的结局。
结果
在 11546 例 15364 例鲍曼不动杆菌培养中，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 68 岁，标准差 12.2），中位 Charlson 指数为 3（四分位距，1-5）。呼吸道标本（n=244，36.6%）和尿液样本（n=187，28%）是最常见的来源；最大比例的患者来自南部（n=162，39.7%）。大多数患者在过去 90 天内接受过抗生素治疗（n=362，88.7%）和住院或长期护理治疗（n=331，81%）。多黏菌素、替加环素和米诺环素显示出最高的敏感性。此外，30 天死亡率（n=96，23.5%）和 1 年死亡率（n=199，48.8%）较高，血培养患者的死亡率显著更高。
结论
退伍军人事务部的鲍曼不动杆菌 XDR 比例较低，但治疗选择极为有限，临床结局较差。预防医院获得性 XDRAB 感染应仍是优先事项，急需新型抗生素治疗 XDRAB。
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