Evaluating the Impact of Antibiotic Exposures as Time-Dependent Variables on the Acquisition of Carbapenem-Resistant Acinetobacter baumannii

L. Silvia Munoz-Price, Rossana Rosa, Jose G. Castro, Panthipa Laowansiri, Rachel Latibeaudiere, Nicholas Namias, Sergey Tarima

Research output: Contribution to journalArticle

13 Scopus 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.

Original languageEnglish (US)
Pages (from-to)e949-e956
JournalCritical care medicine
Volume44
Issue number10
DOIs
StatePublished - Oct 1 2016

Keywords

  • Acinetobacter baumannii
  • carbapenem resistant
  • cohort
  • colonization
  • survival analysis
  • time-dependent variable

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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