Faculty Collaboration Database

Evaluating the Impact of Antibiotic Exposures as Time-Dependent Variables on the Acquisition of Carbapenem-Resistant Acinetobacter baumannii. Crit Care Med 2016 Oct;44(10):e949-56

Date

05/12/2016

Pubmed ID

27167999

DOI

10.1097/CCM.0000000000001848

Scopus ID

2-s2.0-84966710980 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

OBJECTIVES: To determine the time-dependent effect of antibiotics on the initial acquisition of carbapenem-resistant Acinetobacter baumannii.

DESIGN: Retrospective cohort study.

SETTING: Forty-bed trauma ICU in Miami, FL.

PATIENTS: All consecutive patients admitted to the unit from November 1, 2010, to November 30, 2011.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Patients underwent surveillance cultures at admission to the unit and weekly thereafter. The primary outcome was the acquisition of carbapenem-resistant A. baumannii on surveillance cultures. Daily antibiotic exposures during the time of observation were used to construct time-dependent variables, including cumulative exposures (in grams and daily observed doses [defined daily doses]). Among 360 patients, 45 (12.5%) became colonized with carbapenem-resistant A. baumannii. Adjusted Cox models showed that each additional point in the Acute Physiologic and Chronic Health Evaluation score increased the hazard by 4.8% (hazard ratio, 1.048; 95% CI, 1.010-1.087; p = 0.0124) and time-dependent exposure to carbapenems quadrupled the hazard (hazard ratio, 4.087; 95% CI, 1.873-8.920; p = 0.0004) of acquiring carbapenem-resistant A. baumannii. Additionally, adjusted Cox models determined that every additional carbapenem defined daily dose increased the hazard of acquiring carbapenem-resistant A. baumannii by 5.1% (hazard ratio, 1.051; 95% CI, 1.007-1.093; p = 0.0243).

CONCLUSIONS: Carbapenem exposure quadrupled the hazards of acquiring A. baumannii even after controlling for severity of illness.

Author List

Munoz-Price LS, Rosa R, Castro JG, Laowansiri P, Latibeaudiere R, Namias N, Tarima S

Author

Sergey S. Tarima PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

APACHE
Acinetobacter Infections
Acinetobacter baumannii
Adult
Age Factors
Anti-Bacterial Agents
Carbapenems
Comorbidity
Drug Resistance, Bacterial
Female
Florida
Humans
Intensive Care Units
Male
Microbial Sensitivity Tests
Middle Aged
Retrospective Studies
Sex Factors
Time Factors