Surveillance cultures growing carbapenem-resistant acinetobacter baumannii predict the development of clinical infections: A retrospective cohort study

Background. We aimed to determine the effect of the presence of carbapenem-resistant Acinetobacter baumannii in accordance with surveillance cultures on the subsequent development of clinical infections by this organism. Methods. This retrospective cohort study was conducted at a tertiary hospital from January 2010 to November 2011. We included all consecutive patients admitted to the trauma intensive care unit, who had weekly surveillance cultures performed (from rectum, and if intubated, respiratory secretions), and without evidence of A. baumannii infections prior to the collection of the first surveillance culture. Univariable and multivariable analyses were performed using log-binomial regression. Survival analyses were performed using Cox proportional hazards. Results. Three hundred sixty-four patients were included, of whom 49 (13.5%) had carbapenem-resistant A. baumannii on surveillance cultures. Patients with positive surveillance cultures had 8.4 (95% confidence interval [CI], 5.6-12.7; P <. 0001) times the risk of developing a subsequent A. baumannii infection compared with patients who remained negative on surveillance cultures. Multivariable analysis showed significant associations between clinical infection and both positive surveillance cultures (relative risk [RR], 5.9 [95% CI, 3.8-9.3]; P <. 0001) and mechanical ventilation (RR, 4.3 [95% CI, 1.03-18.2]; P =. 05). On survival analyses, the only variable associated with the development of clinical infections was the presence of positive surveillance cultures (hazard ratio, 16.3 [95% CI, 9.1-29.1]; P <. 001). Conclusions. Presence of carbapenem-resistant A. baumannii on surveillance cultures is strongly associated with subsequent development of carbapenem-resistant A. baumannii infections. Prevention efforts should be focused at limiting the acquisition of this organism during hospitalization.