ID WEEK 2016 POSTER ABSTRACTS 295. Clinical Outcomes of Bloodstream Infections Due to VancomycinResistant Enterococcus faecium Rachel V. Marini, PharmD1; Ryan K. Shields, PharmD2; Lloyd Clarke, BScHons2; Cornelius J. Clancy, MD2; Minh-Hong Nguyen, MD2; J. Alexander Viehman, MD3; 1 Pharmacy, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania; 2University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania; 3Infectious Disease, University of Pittsburgh, Pittsburgh, Pennsylvania Session: 54. HAI: MSSA, MRSA, and other Gram-Positives Thursday, October 27, 2016: 12:30 PM Background. Treatment options for vancomycin-resistant Enterococcus faecium (VRE) infections are limited. We defined our VRE antibiogram, and evaluated clinical responses among patients ( pts) treated for VRE bloodstream infections (BSIs). Methods. Retrospective review of consecutive pts with VRE BSI (2012–2015). Ampicillin susceptible (S) or E. faecalis isolates were excluded. Clinical success was defined as 30-day survival with clinical improvement and absence of persistent or recurrent VRE BSI.
Results: Ninety-eight. 98 pts were enrolled. Median age was 58 years (range: 21– 86). Sixty percent were men. Sixty-two percent were immunocompromised. At onset of VRE BSI, 73% were in an ICU, 43% required renal replacement therapy, and median Pitt Bacteremia Score (PBS) was 7 (0–13). Portals of entry were central venous catheters in 35% and abdomen in 34%. Using microscan or Etest, 22% and 1% of VRE were daptomycin (DAP) and linezolid (LZD) NS, respectively (P < 0.001). Thirty-day survival and clinical success rates were 63% and 41%, respectively. Success rates were similar among pts treated with DAP (44% [17 of 39]), LZD (39% [22 of 56]), or quinupristin-dalfopristin (33% [1 of 3]). Linezolid success was 39% and 45% against DAP-NS and -S, respectively. Linezolid was used more often against DAP-NS than DAP-S isolates (P = 0.01). By multivariate analysis, PBS was associated with failure (P = 0.08). Treatment was discontinued in 5% and 21% of pts on DAP or LZD, respectively, due to adverse events or persistent infection (P = 0.04). Rates of recurrent BSI (8% within 90 days of initial BSI) did not vary between agents. Sixty-three percent of recurrent VRE isolates were DAP-NS; 0% were LZD-NS (P = 0.025). Eighty-eight percent and 63% of pts with recurrent BSI were previously exposed to DAP or LZD, respectively. Sixty-three percent and 37% of pts with recurrent BSI were treated with the same or alternative agent, respectively. Twenty-five percent of pts died during recurrent BSI treatment; another 25% had a third VRE BSI within 90 days. Conclusion. Clinical success was achieved in a minority of patients treated for VRE BSI, despite the use of agents that were active in vitro. It was particularly worrisome that 22% of VRE were DAP-NS, and 21% of pts on LZD discontinued treatment. New, better-tolerated agents for VRE are needed. Microscan/Etest may assign higher DAP MICs than broth microdilution methods, but our results suggest that potential over-calling of DAP-NS did not impact outcomes. Disclosures. R. K. Shields, Merck: Grant Investigator, Research support. Astellas: Grant Investigator, Research support
Some abstract images in the OFID IDWeek 2016 Abstract Supplement may be unclear. In those instances, it is recommended that you use the IDWeek Interactive Program Planner to view the abstract and images. The Program Planner can be found here: https://idsa.confex.com/idsa/2016/webprogram/start.html. Open Forum Infectious Diseases 2016;1(S1):S1–285 © The Author 2016. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/ by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact
[email protected]. DOI: 10.1093/ofid/ofw172
Poster Abstracts
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