Acinetobacter baumannii 2002-2008: Increase of Carbapenem-Associated Multiclass Resistance in the United States

The study consisted of data for 55,330 U. S. Acinetobacter baumannii isolates from The Surveillance Network (R) database for the period 2002-2008. Risk factors were time, age, sex, census region, location (Ward or ICU), and isolate source. Antimicrobial susceptibility data were available for carbapenems, cephalosporins, aminoglycosides, fluoroquinolones, and beta-lactam/beta-lactamase inhibitor combinations. Multiclass resistance was defined as nonsusceptibility to carbapenems and two or more additional classes. Odds of resistance were obtained using a logistic regression model with cubic splines. Carbapenem-associated multiclass resistance has had a 3.7-fold (95% confidence interval [CI] 3.4-4.3) increase from 20.6% in 2002 to 49.2% in 2008. Among blood isolates the increase was by 2.2 times (95% CI 1.7-2.9). Subjects <18 years old had significantly (p<0.001) lower rates in 2002 (6.9%) than those 65 years or older (21.5%), but by 2008 this difference diminished as rates increased to 44.2% and 54.2%, respectively. A similar divergence was also observed between ICU and Ward, with no differences in 2002, whereas in 2008 ICU isolates had significantly higher rates (55.2%, 95% CI 53.6%-56.9%) than Ward isolates (45.6%, 95% CI 44.2%-47.0%). Over half of all A. baumannii-resistant isolates were carbapenem and multiclass resistant in 2008. Rates among subjects <18 years old have increased faster than those of the elderly, and in the ICU as compared to Ward.