Carbapenem-resistant Acinetobacter baumannii complex infections and SARS-CoV-2 positivity in 9 U.S. sites, 2020-2022

Author/Creator ORCID





Citation of Original Publication

Bulens, Sandra N, Amanda Hall, Jesse T Jacob, Gillian Smith, Lucy E Wilson, Elisabeth Vaeth, Christopher Wilson, et al. “2458. Carbapenem-Resistant Acinetobacter Baumannii Complex Infections and SARS-CoV-2 Positivity in 9 U.S. Sites, 2020-2022.” Open Forum Infectious Diseases 10, no. Supplement_2 (December 1, 2023): ofad500.2076.


This work was written as part of one of the author's official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 U.S.C. 105, no copyright protection is available for such works under U.S. Law.
Public Domain



Background Reports have shown increases in carbapenem-resistant Acinetobacter baumannii complex (CRAB) infections during the COVID-19 pandemic. To describe the effect of SARS-CoV-2 (SC2) infection on CRAB infection epidemiology, we analyzed data from the Centers for Disease Control and Prevention’s Emerging Infections Program (EIP) population-based CRAB surveillance in 9 U.S. sites. graphic Methods: In 2020–22, among surveillance-area residents, an incident CRAB case was defined as the 1st isolation of A. baumannii complex resistant to ≥1 carbapenem (excluding ertapenem) from a normally sterile site or urine (or lower respiratory tract or wound, as of 2021) in a 30-day period. We included cases that underwent chart review. Cases with a culture collected ≥3 days after hospitalization were considered hospital-onset (HO); all others were community-onset (CO). Cases with a SC2+ test ≤14 days before the incident CRAB culture were compared to other CRAB cases. Results Of 406 CRAB cases representing 344 patients, 26 (6%) cases in 24 patients were SC2+. SC2+ case-patients were more likely to be female than other CRAB case-patients (58% vs 34%, p=0.02); there were no significant differences in race/ethnicity or age distribution. SC2+ cases were more likely to be obese (42% vs. 23%, p=0.03), have bacteremia (23% vs. 10%, p=0.05), and to have died (39% vs. 16%, p=0.003). SC2+ cases were also more likely to require hospitalization (100% vs. 75%, p=0.005) and have HO CRAB (58% vs 29%, p=0.003). Median hospital length of stay was longer in SC2+ cases (19 days, interquartile range [IQR] 8–30) than in other CRAB cases (14 days, IQR 7–26, p=0.42), but there were no significant differences in the percentages with intensive care unit stays or mechanical ventilation in the 7 days before CRAB culture. Culture sources and infection types in SC2+ cases vs. other CRAB cases are shown in the Table. Conclusion A small minority of CRAB patients were infected with SC2+ in the 14 days before CRAB infection but these patients had epidemiological and clinical features that were distinct from other CRAB patients, including higher mortality. Infection control and clinical measures are needed to protect SC2+ patients from secondary bacterial infection and mitigate poor outcomes in those with SC2 and CRAB infection.