• L Silvia Munoz-Price, Rossana Rosa, Jose G Castro, Panthipa Laowansiri, Rachel Latibeaudiere, Nicholas Namias, and Sergey Tarima.
• 1Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI.2Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.3Department of Medicine, Jackson Memorial Hospital, Miami, FL.4Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL.5Department of Medicine, Orlando Health System and South Lake Hospital, Clermont, FL.6Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
• Crit. Care Med. 2016 Oct 1; 44 (10): e949-56.

ObjectivesTo determine the time-dependent effect of antibiotics on the initial acquisition of carbapenem-resistant Acinetobacter baumannii.DesignRetrospective cohort study.SettingForty-bed trauma ICU in Miami, FL.PatientsAll consecutive patients admitted to the unit from November 1, 2010, to November 30, 2011.InterventionsNone.Measurements And Main ResultsPatients underwent surveillance cultures at admission to the unit and weekly thereafter. The primary outcome was the acquisition of carbapenem-resistant A. baumannii on surveillance cultures. Daily antibiotic exposures during the time of observation were used to construct time-dependent variables, including cumulative exposures (in grams and daily observed doses [defined daily doses]). Among 360 patients, 45 (12.5%) became colonized with carbapenem-resistant A. baumannii. Adjusted Cox models showed that each additional point in the Acute Physiologic and Chronic Health Evaluation score increased the hazard by 4.8% (hazard ratio, 1.048; 95% CI, 1.010-1.087; p = 0.0124) and time-dependent exposure to carbapenems quadrupled the hazard (hazard ratio, 4.087; 95% CI, 1.873-8.920; p = 0.0004) of acquiring carbapenem-resistant A. baumannii. Additionally, adjusted Cox models determined that every additional carbapenem defined daily dose increased the hazard of acquiring carbapenem-resistant A. baumannii by 5.1% (hazard ratio, 1.051; 95% CI, 1.007-1.093; p = 0.0243).ConclusionsCarbapenem exposure quadrupled the hazards of acquiring A. baumannii even after controlling for severity of illness.

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