title: Risk factors for and impact of carbapenem-resistant Acinetobacter baumannii colonization and infection: matched case-control study.
abstract: The objective of this investigation was to identify risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) and its association with mortality. A population-based matched case-control study using the computerized database of Clalit Health Services (CHS) in the period between 2007 and 2012 was conducted. Hospitalized patients with CRAB colonization or infection were compared to hospitalized patients without evidence of A. baumannii, matched by age, ward of hospitalization, season, Charlson score, and length of hospitalization. Risk factors for CRAB isolation were searched for using multivariate analysis. Association of CRAB and other risk factors with mortality were assessed in the cohort. A total of 1190 patients with CRAB were matched to 1190 patients without CRAB. Low socioeconomic status was independently associated with CRAB isolation and CRAB bacteremia [odds ratio 2.18, 95% confidence interval (CI) 1.02-5]. Other risk factors were invasive procedures and bacteremia with other pathogens prior to CRAB isolation, and various comorbidities. Among all patients, CRAB isolation was independently associated with increased mortality (hazard ratio 2.33, 95% CI 2.08-2.6). Socioeconomic status is associated with health outcomes. Our population-based study revealed an almost doubled risk for CRAB in patients at lower socioeconomic status and an association with healthcare exposure. CRAB was associated with mortality and might become a risk indicator for complex morbidity and mortality.
authors.affiliation: Infectious Disease Unit, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel. oryan.henig@gmail.com.|Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel. oryan.henig@gmail.com.
authors.forename: O
authors.initials: O
authors.lastname: Henig
authors.affiliation: Infectious Disease Unit, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel.|Technion Faculty of Medicine, Haifa, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Weber
authors.affiliation: Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.
authors.forename: M B
authors.initials: MB
authors.lastname: Hoshen
authors.affiliation: Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Paul
authors.affiliation: Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.
authors.forename: L
authors.initials: L
authors.lastname: German
authors.affiliation: Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.|Technion Faculty of Medicine, Haifa, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Neuberger
authors.affiliation: Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Gluzman
authors.affiliation: Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Berlin
authors.affiliation: Technion Faculty of Medicine, Haifa, Israel.|Lady Davis Carmel Medical Center, Haifa, Israel.
authors.forename: C
authors.initials: C
authors.lastname: Shapira
authors.affiliation: Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.|Public Health Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: R D
authors.initials: RD
authors.lastname: Balicer
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D040981:Acinetobacter baumannii / Q000187:drug effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D016022:Case-Control Studies; D015331:Cohort Studies; D003428:Cross Infection / Q000188:drug therapy*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems