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Assessing antibiotic utilization trends and outcomes in patients with carbapenem-resistant Acinetobacter baumannii
Ana Pranjic1, Ursula Patel1, Thanh-Huyen T Vu2
1Department of Pharmacy, Edward Hines, Jr. VA Hospital, Hines, IL.
Insights
Antibiotic use for carbapenem-resistant Acinetobacter baumannii (CRAB) infections shifted over time. Combination therapy was linked to higher mortality rates in veterans, suggesting greater illness severity.
Area of Science:
- Infectious Diseases
- Antimicrobial Resistance
- Public Health
Background:
- Carbapenem-resistant Acinetobacter baumannii (CRAB) poses a significant public health challenge due to limited treatment options and increasing resistance.
- Effective management strategies for CRAB infections are crucial for improving patient outcomes.
Purpose of the Study:
- To analyze trends in antibiotic utilization for CRAB infections within the Department of Veterans Affairs (VA) patient population.
- To evaluate the association between antibiotic treatment strategies and patient mortality in CRAB infections.
Main Methods:
- A national retrospective cohort study of veterans diagnosed with CRAB between January 2018 and December 2023.
- Analysis of VA registries and patient charts for demographics, CRAB cultures, antimicrobial treatments, and mortality data.
- Descriptive statistics and logistic regression were employed to analyze the data, accounting for patient clustering.
Main Results:
- Trends showed increased use of ampicillin-sulbactam, tetracycline, and cephalosporins, with a decrease in polymyxin use.
- CRAB isolates demonstrated the highest susceptibility to aminoglycosides.
- Combination antibiotic therapy was associated with significantly higher 30- and 90-day mortality rates compared to monotherapy (OR 2.97, CI 1.35-6.51; OR 2.75, CI 1.29-5.84).
Conclusions:
- Antimicrobial prescribing patterns for CRAB infections evolved, aligning with updated treatment guidelines.
- Higher mortality observed in patients receiving combination therapy likely indicates a reflection of more severe underlying illness.
Background:
Carbapenem-resistant Acinetobacter baumannii (CRAB) remains an urgent public health threat due to challenges with resistance and treatment. This study evaluated antibiotic utilization trends and outcomes in the treatment of CRAB infections in the Department of Veteran Affairs (VA) patient population.
Methods:
This national retrospective cohort study included veterans with at least one positive culture for CRAB between January 2018 to December 2023. Data from national VA registries, along with chart reviews, were analyzed for demographics, microbial cultures, antimicrobial treatment(s), and mortality. Descriptive statistics and logistic regression, accounting for clustering within patients, were used.
Results:
Among 717 unique patients with 946 monomicrobial and polymicrobial CRAB cultures of 717 unique patients across 75 VA facilities, 352 monomicrobial cultures of 302 unique patients were identified. Ampicillin-sulbactam, tetracycline, and cephalosporin use increased over time (P < .002, P < .001, P = .005), whereas polymyxin use decreased over time (P = .009). CRAB isolates were most frequently susceptible to aminoglycosides. Adjusted analyses revealed higher 30- and 90-day mortality rates in patients that received combination versus monotherapy; OR 2.97, CI (1.35-6.51), OR 2.75, CI (1.29-5.84).
Conclusions:
Antimicrobial use for CRAB infections changed as updated guidelines were adopted. Mortality rates were highest among patients receiving combination therapy, likely reflecting greater severity of illness.
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