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Acinetobacter infections may be increasing in the community
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Community-acquired Acinetobacter infections became nearly 15% more resistant to eight studied antibiotics over a six-year period, according to results of a recent study.
Data for clinical Acinetobacter cultures obtained from 2003 to 2008 were collected from the microbiology databases of the four hospitals in the Oakwood Healthcare System in Detroit.
Eligible patients were 60 years or older and had been admitted from home or nursing homes. Discharge destinations — including home, nursing home, long-term acute-care facility, another hospital, hospice or death — were also recorded.
The strain of the initial Acinetobacter isolate and susceptibility information for eight antibiotics per isolate were recorded. Infections were categorized as nosocomial if the initial culture had been obtained 48 hours after hospitalization.
Isolates from 560 patients from the community (mean age ± standard deviation, 74 ± 8.6 years) and 280 patients from in nursing homes (78 ± 9.1 years) were involved in the analysis.
A 25% increase in Acinetobacter prevalence was observed over the study period (P<.001, by trend test).
Resistance to imipenem and ampicillin/sulbactam increased from 1.8% to 33.1% (P<.001) from 2003 to 2008. Resistance to all eight studied antibiotics, which the researchers called “panresistance,” increased from 0% to 13.6% (P<.001).
Community-acquired isolates were resistant to approximately 4.2 antibiotics throughout the study period. However, between 2003 and 2008, resistance increased from 4.5 to 5.7 antibiotics among nursing home-acquired isolates and from five to six antibiotics among nosocomial-acquired isolates (P<.01).
Discharge information indicated that 25% of patients from the community and 50% of patients from nursing homes returned to their place of origin. The remainder required higher levels of care or died, according to the results.
Results of a multivariate analysis indicated that the OR for discharge to a higher level of care or death was 1.23 (95% CI, 1.11-1.36) for resistance to each additional antibiotic. The analysis included adjustments for age, length of stay and origin.
“Patients with resistant isolates are selectively discharged to nursing homes and long-term acute-care facilities, introducing resistance to new facilities,” the researchers wrote.
Sengstock DM. Clin Infect Dis. 2010;50:1611–1616.