Long-term care facilities see far more A. baumannii and C. auris
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Key takeaways:
- Maryland performed a statewide prevalence survey of Acinetobacter baumannii and Candida auris.
- Both were far more prevalent among patients in long-term care than acute care facilities.
BOSTON — Mechanically ventilated patients in long-term care facilities are far more likely to be colonized by Acinetobacter baumannii and Candida auris than those in acute-care facilities, a study found.
Both pathogens are on the CDC’s list of the five most urgent antibiotic resistance threats in the United States, along with Clostridioides difficile, carbapenem-resistant Enterobacterales and drug-resistant gonorrhea.
Although the new study by Anthony Harris, MD, MPH, a professor of epidemiology and public health at the University of Maryland School of Medicine, and colleagues found that A. baumannii was up to seven times more likely to be identified in mechanically ventilated patients than C. auris, both pathogens were common. In fact, around one in 14 patients in the study were colonized by C. auris.
Every eligible health care facility in Maryland — 18 long-term care facilities and 33 acute-care hospitals — responded to a prevalence survey for A. baumannii and C. auris that was conducted between March 7 and June 8 this year by the Maryland MDRO Prevention Collaborative.
It was the first statewide survey of C. auris in the U.S. and only the second of A. baumannii, according to Harris and colleagues.
Harris presented the group’s findings on Thursday at IDWeek. Their study was published simultaneously in JAMA.
“This prevalence represents a substantial burden to the health care system and suggests a large reservoir for potential transmission both to other patients within health care facilities and among different health care facilities when patients are transferred between care settings,” the researchers wrote in JAMA.
Surveillance data have shown that cases of C. auris — an aggressive and frequently drug-resistant fungus linked to hospital outbreaks — have increased substantially in recent years, including in areas of the U.S. that had previously recorded few or no cases.
According to the CDC, Acinetobacter is “constantly finding new ways to avoid the effects” of antibiotics. Earlier this year, the FDA approved IV sulbactam-durlobactam to treat resistant strains of the bacteria.
Harris and colleagues included a total of 482 mechanically ventilated patients in their analysis. Testing showed that 31% of the patients were colonized by A. baumannii, 18% by carbapenem-resistant A. baumannii (CRAB) and 7% by C. auris.
Patients in long-term care were more than seven times as likely to be colonized by A. baumannii, (RR = 7.7; 95% CI, 5.1-11.5), more than five times as likely to be colonized by CRAB (RR = 5.5; 95% CI, 3.4-8.9) and twice as likely to be colonized by C. auris (RR = 2; 95% CI, 0.99-3.9) compared with patients in acute-care hospitals.
The study identified nine previously unknown cases of C. auris.
“We were surprised by the high prevalence of C. auris,” Harris told Healio. “We were not surprised but still shocked by the high prevalence of carbapenem-resistant A. baumannii colonization.”
Harris said the study should inform how Maryland and other states prioritize infection and prevention resources, and that more states should conduct similar prevalence studies of ventilated patients.
“More resources should be committed to infection control programs at long-term care facilities and to state health departments,” he said.
More resources should also go toward decolonization efforts, Harris said.
“This could improve patient outcomes by preventing infection with emerging pathogens and by preventing transmission of emerging pathogens to other patients,” he said. “This needs to focus on the development of new pathogen burden reduction agents, especially involving the gastrointestinal tract.”
References:
- CDC. Acinetobacter in health care settings. https://www.cdc.gov/hai/organisms/acinetobacter.html. Last reviewed Nov. 13, 2019. Accessed Oct. 12, 2023.
- CDC. AR threats report. https://www.cdc.gov/drugresistance/biggest-threats.html. Last reviewed Nov. 23, 2021. Accessed Oct. 10, 2023.
- Harris AD, et al. Abstract 970. Presented at: IDWeek; Oct. 11-15, 2023; Boston.
- Harris AD, et al. JAMA. 2023;doi:10.1001/jama.2023.21083.
Perspective
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This interesting epidemiologic report by Dr. Anthony Harris is a point prevalence survey in the state of Maryland in 2023 looking at colonization of mechanically ventilated patients with A. baumannii, CRAB and C. auris. The research team found that colonization with these organisms is common among mechanically ventilated patients in both acute-care hospitals and long-term care facilities. Of note, they found that both pathogens were significantly more common in long-term care facilities than in acute-care facilities and that ventilated patients in long-term care facilities in Maryland are at high risk for colonization with these organisms, which frequently have multidrug resistance.
This is important for a couple of reasons. These infections can be difficult to treat due to antibiotic resistance and can put other patients in these acute- and long-term care facilities at risk for acquiring these organisms. The organisms can be spread in a health care facility from person to person through direct contact via health care workers’ hands or through shared medical equipment.
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Harris A, et al. Abstract 970. Presented at: IDWeek; Oct. 11-15, 2023; Boston.
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