Acinetobacter baumannii Resistance Trends in Children in the United States, 1999-2012
Latania K Logan1,2,3, Sumanth Gandra4, Anna Trett4
1Department of Pediatrics, Division of Infectious Diseases, Rush Medical College, Rush University Medical Center, Chicago, Illinois.
Insights
Carbapenem-resistant Acinetobacter baumannii infections increased in US children from 1999-2012, with a notable decrease in resistance trends after 2008. Ongoing surveillance is crucial for vulnerable populations.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial resistance epidemiology
- Healthcare-associated infections
Background:
- Acinetobacter baumannii is a frequent cause of healthcare-associated infections.
- Carbapenem-resistant (CR) A. baumannii poses a significant global health threat.
- Pediatric A. baumannii epidemiology in the US requires further investigation.
Purpose of the Study:
- To analyze trends in antibiotic resistance of A. baumannii in children in the United States.
- To assess the prevalence of cephalosporin-resistant (CephR) and CR A. baumannii over time.
- To identify changes in resistance patterns after 2008.
Main Methods:
- Utilized antimicrobial susceptibility data from The Surveillance Network (1999-2012).
- Phenotypically identified antibiotic resistance in A. baumannii isolates from children aged 1-17 years.
- Employed logistic regression to determine resistance trends and associated odds ratios (OR) and confidence intervals (CI).
Main Results:
- Cephalosporin resistance (CephR) increased from 13.2% (1999) to 23.4% (2012), peaking at 32.5% (2008).
- Carbapenem resistance (CR) increased from 0.6% (1999) to 6.1% (2012), peaking at 12.7% (2008).
- Annual increases of 3% for CephR and 8% for CR were observed until 2008, followed by significant decreases (CephR OR=0.78; CR OR=0.73), though resistance remained elevated.
Conclusions:
- CephR and CR A. baumannii isolates increased in children between 1999 and 2012, with a declining trend observed after 2008.
- Despite the decrease post-2008, resistance levels remained higher than baseline.
- Continuous surveillance and evaluation of prevention strategies are essential for managing A. baumannii infections in pediatric populations.
Background:
Acinetobacter baumannii is a common cause of healthcare-associated infections. Carbapenem-resistant (CR) A baumannii is a significant threat globally. We used a large reference laboratory database to study the epidemiology of A baumannii in children in the United States.
Methods:
Antimicrobial susceptibility data from The Surveillance Network were used to phenotypically identify antibiotic resistance in A baumannii isolates in children 1-17 years of age between January 1999 and July 2012. Logistic regression analysis was used to calculate trends in the prevalence of antibiotic resistance in A baumannii. Isolates from infants (<1 year old) were excluded.
Results:
The crude proportion of cephalosporin-resistant (CephR) A baumannii increased from 13.2% in 1999 to 23.4% in 2012 with a peak of 32.5% in 2008, and the proportion of CR A baumannii increased from 0.6% in 1999 to 6.1% in 2012 with a peak of 12.7% in 2008. From 1999 to 2012, the proportion of CephR and CR A baumannii increased each year by 3% and 8%, respectively (CephR odds ratio [OR] = 1.03, 95% confidence interval [CI], 1.01-1.04; CR OR = 1.08, 95% CI, 1.05-1.12); however, after 2008, a significant decrease in trend was observed (CephR OR = 0.78, 95% CI, 0.71-0.87; CR OR = 0.73, 95% CI, 0.62-0.86), but resistance remained higher than baseline (1999).
Conclusions:
Overall, between 1999 and 2012, CephR and CR A baumannii isolates increased in children; however, a decreasing trend was observed after 2008.There is a need for ongoing surveillance of A baumannii infections and continued assessment of effective prevention strategies in vulnerable populations.
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