Treatment of extensively-drug resistant (XDR) Acinetobacter and impact on clinical outcomes in US veterans affairs (VA) medical centers

摘要

Background: Guidelines for treatment of resistant Acinetobacter baumannii (AB) are limited, leaving a knowl-edge gap in best practices for treatment. This study described treatments and outcomes of extensively-drug resistant (XDR) AB.Methods: Retrospective cohort study including patients with XDRAB (non-susceptible to at least 1 agent in all but 2 or fewer classes) and antibiotic treatment between 2012 and 2018 at Veterans Affairs Medical Centers. Descriptive statistics summarized antibiotics; propensity score adjusted regression models were fit to com-pare outcomes.Results: Two hundred and seventy-six patients with 439 XDRAB cultures and Gram-negative targeted antibi-otic treatment were included. One hundred and eighteen (43) patients received monotherapy while 158 (57) received combination therapy, most commonly including a carbapenem (n = 106, 67) and polymyxin (n = 66, 42). One hundred and eighty-four (67) patients received inadequate treatment. In adjusted mod-els, combination therapy did not decrease the odds of in-hospital (aOR 1.24, 95CI 0.60-2.59) or 30-day (aOR 1.43, 95CI 0.86-2.38) mortality, or median postculture length of stay (aIRR 1.11, 95CI 0.86-1.43). Likewise, receipt of inadequate treatment was not associated with poorer outcomes.Conclusions: In this national cohort of patients with XDRAB, neither combination therapy nor receipt of ade-quate treatment improved outcomes. Further research is needed on optimal management of this difficult-to -treat pathogen with few effective antibiotic options.Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.