Brief Report
October 12, 2023
Prevalence of Acinetobacter baumannii and Candida auris in Patients Receiving Mechanical Ventilation
Anthony D. Harris, Lisa Pineles, J. Kristie Johnson, et al
JAMA. Published online October 12, 2023. doi:10.1001/jama.2023.21083
Question What is the statewide prevalence of 2 emerging pathogens, Acinetobacter baumannii and Candida auris, among patients receiving mechanical ventilation?
Findings A baumannii was identified in 30.7%, carbapenem-resistant A baumannii (CRAB) in 59.5% of those samples, and Candida auris was identified in 6.6% of all patients receiving mechanical ventilation in Maryland. Patients in long-term care facilities were more likely to be colonized with A baumannii, CRAB, and C auris compared with patients in acute care facilities.
Meaning This study should be repeated in other US states to determine the burden of these pathogens among patients receiving mechanical ventilation. Increased surveillance and prevention efforts should be directed at long-term care facilities.
Abstract
Importance To date, only 1 statewide prevalence survey has been performed for Acinetobacter baumannii (2009) in the US, and no statewide prevalence survey has been performed for Candida auris, making the current burden of these emerging pathogens unknown.
Objective To determine the prevalence of A baumannii and C auris among patients receiving mechanical ventilation in Maryland.
Design, Setting, and Participants The Maryland Multi-Drug Resistant Organism Prevention Collaborative performed a statewide cross-sectional point prevalence of patients receiving mechanical ventilation admitted to acute care hospitals (n = 33) and long-term care facilities (n = 18) between March 7, 2023, and June 8, 2023. Surveillance cultures (sputum, perianal, arm/leg, and axilla/groin) were obtained from all patients receiving mechanical ventilation. Sputum, perianal, and arm/leg cultures were tested for A baumannii and antibiotic susceptibility testing was performed. Axilla/groin cultures were tested by polymerase chain reaction for C auris.
Main Outcomes and Measures Prevalence of A baumannii, carbapenem-resistant A baumannii (CRAB), and C auris. Prevalence was stratified by type of facility.
Results All 51 eligible health care facilities (100%) participated in the survey. A total of 482 patients receiving mechanical ventilation were screened for A baumannii and 470 were screened for C auris. Among the 482 patients who had samples collected, 30.7% (148/482) grew A baumannii, 88 of the 148 (59.5%) of these A baumannii were CRAB, and C auris was identified in 31 of 470 (6.6%). Patients in long-term care facilities were more likely to be colonized with A baumannii (relative risk [RR], 7.66 [95% CI, 5.11-11.50], P < .001), CRAB (RR, 5.48 [95% CI, 3.38-8.91], P < .001), and C auris (RR, 1.97 [95% CI, 0.99-3.92], P = .05) compared with patients in acute care hospitals. Nine patients (29.0%) with cultures positive for C auris were previously unreported to the Maryland Department of Health.
Conclusions A baumannii, carbapenem-resistant A baumannii, and C auris were common among patients receiving mechanical ventilation in both acute care hospitals and long-term care facilities. Both pathogens were significantly more common in long-term care facilities than in acute care hospitals. Patients receiving mechanical ventilation in long-term care facilities are a high-risk population for emerging pathogens, and surveillance and prevention efforts should be targeted to these facilities.
