acinetobacterbaumannii in nursing homes 1159
table 2. Clustered Exact Logistic Regression of Multidrug-Resistant Acinetobacter baumannii Colonization as a Function of Organism Organism
Enterobacter cloacae Escherichia colia
Klebsiella pneumoniaea Morganella morgannii Proteus mirabilisa Providencia stuartii
Pseudomonas aeruginosa Pseudomonas fluorescens
Stenotrophomonas maltophilia
Methicillin-resistant Staphylococcus aureusa Vancomycin-resistant Enterococcusa
Cases (n=25) 1 (4)
11 (44) 5 (20) 1 (4)
14 (56) 3 (12) 4 (16) 4 (16) 1 (4)
11 (44) 12 (48)
cases was less than 3. aAnalysis using exact logistic regression with clustered standard error estimation.
table 3. Frequency of Resistant Gram-Negative Bacteria Co-colonizing with Multidrug-Resistant Acinetobacter baumannii, by Body Site of Isolation
No. of Isolates Organism Proteus mirabilis
Perianal area (n=19)
12 Groin
(n=15) 10
Wound (n=13)
7
Escherichia coli 93 2 Klebsiella pneumoniae 73 3 Pseudomonas fluorescens 00 2 Providencia stuartii 10 1 Proteus vulgaris 01 1 Enterobacter cloacae 01 0 Morganella morgannii 10 0 Pseudomonas aeruginosa 00 2
table 4. Adjusted Multivariable Analysis With Multidrug- Resistant Acinetobacter baumannii Colonization as Outcome
Risk factor/organism PSMS >24
Prior colonization with P. mirabilis Diabetes mellitus
Adjusted OR (95% CI) 5.1 (1.8–14.9)
5.8 (1.9–17.9) 3.4 (1.2–9.9)
P
<.004 <.003 <.03
NOTE. OR, odds ratio; P. mirabilis, Proteus mirabilis; PSMS, Physical Self-Maintenance Score.
colonization using an augmented logistic model. Predictors included PSMS score, diabetes, presence of both a feeding tube and urinary catheter, P. mirabilis colonization, Pseudomonas fluorescens colonization, length of stay at baseline, and number of follow-up days. Because length of stay measured at baseline and number of
follow-up days were highly correlated with the other pre- dictors, they were not included in the final augmented model. Individuals with a length of stay of at least 30 days (time at the
Suprapubic catheter insertion site (n=1)
1 0 0 0 0 0 0 0 0
Total
(n=48) 30
14 13 2 2 2 1 1 2
facility prior to enrollment in the study) were 5.6 times more likely to be colonized withMDR A. baumannii than those with shorter length of stay (95% CI, 1.8–17.1; P<.003). Similarly, those with at least 60 days of follow-up were 6.1 times more likely to be colonized (95% CI, 2.1–17.5; P<.002). The final augmented model indicated that the most robust effects were functional disability (PSMS score >24), colonization with P. mirabilis, and diabetes (Table 4). Those with high functional disability were 5.1 times more likely to be colonized withMDR A. baumannii (95% CI, 1.8–14.9; P<.004). Being colonized with P. mirabilis was associated with a 5.8 greater likelihood of MDR A. baumannii colonization (95% CI, 1.9–17.9; P<.003), and diabetic participants were 3.4 times more likely to be colonized (1.2–9.9; P<.03).
discussion
In this nested case-control study we explored the epidemiology ofMDR A. baumannii colonization along with predictors of its colonization among short-stay or long-stay NH residents with
Controls (n=143) OR
1.6 1.5
P
12 (8) …… 33 (23) 13 (9)
.5 .8
24 (17) 12 (8) 10 (7) 5 (3)
61 (43) 35 (24)
9 (6) …… 6.3 0.7 2.6 9.6
3 (2) …… 0.6 2.4
.1 NOTE. Data are no. (%) of cases or controls unless otherwise indicated. Odds ratios (ORs) were not calculated if frequency of predictors in the
<.002 >.99 .3
.02 .5
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140