Shelby Reed, PhD2; Vance Fowler Jr, MD4; 1Division of Infectious Diseases, Duke ... Institute, Durham, North Carolina; 3Division of Infectious Diseases and ...
818. Risk Factors for and Clinical Outcomes of Multidrug-Resistant GramNegative Bacterial Bloodstream Infections: Initial Results From a 12-Year Prospective Cohort Study Joshua T. Thaden, MD, PhD1; Yanhong Li, MD2; Felicia Ruffin, RN, MSN3; Shelby Reed, PhD2; Vance Fowler Jr, MD4; 1Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina; 2Duke Clinical Research Institute, Durham, North Carolina; 3Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina; 4Duke University Medical Center, Durham, North Carolina Session: 132. Bacteremia and Endocarditis Friday, October 9, 2015: 12:30 PM Background. The clinical impact of and risk factors for bloodstream infections (BSI) due to multidrug-resistant (MDR) Gram-negative bacteria (GNB) are incompletely understood. Methods. From 2002 to 2015, all adult, non-neutropenic inpatients with monomicrobial GNB BSI were prospectively enrolled at Duke University Hospital. MDR was defined as resistant to ≥3 antibiotic classes. Risk factors and clinical outcomes associated with MDR status were identified. Results. 1543 unique patients were prospectively enrolled during the study period. Of these, 422 (27%) had MDR bacteria. The most common causes of BSI were Escherichia coli (38%), Klebsiella species (21%), Pseudomonas aeruginosa (10%), and Enterobacter species (7%). MDR organisms were more common in patients with
hematological or solid-organ transplants (70 of 205 [34%] versus 352 of 1338 [26%]; P = 0.02). In a multivariable logistic regression analysis, MDR phenotype was associated with dialysis dependence (odds ratio [OR] 1.57; 95% confidence interval [CI] 1.07–1.32), transplant (OR 1.50; CI 1.00–1.23), and malignancy (OR 1.39; CI 1.08–1.79). In-hospital mortality (19% versus 21%, P = 0.79) and presence of complications (acute kidney injury, septic shock, acute respiratory distress syndrome, shock liver, disseminated intravascular coagulation, stroke, and/or death) (48% versus 50%, P = 0.30) did not differ between MDR and non-MDR groups, though hospital length of stay (LOS) was longer in the MDR group (mean 20.8 days [standard deviation 32.7] versus 15.7 [21.8]; P = 0.01). Negative binomial regression analysis revealed that the MDR phenotype (OR 1.20; 95% CI 1.09–1.32), dialysis-dependence (OR 1.53; CI 1.32–1.77), recent glucocorticoid use (OR 1.23; CI 1.09–1.40), history of GNB infections (OR 1.13; CI 1.03– 1.24), recent surgery (OR 1.15; 1.04–1.28), and hospital-acquisition of BSI (OR 3.30; CI 2.99–3.64) were independently associated with longer hospital LOS. In transplant recipients there was a significant association between MDR BSI and BSI recurrence (MDR, 4 of 70 [5.7%]; Non-MDR, 1 of 135 [0.7%]; P = 0.05). Conclusion. MDR GNB BSI are associated with immunosuppressed patients and longer hospitalizations. In transplant recipients, MDR GNB BSI were associated with higher BSI recurrence. Disclosures. J. T. Thaden, Cubist: Investigator, Grant recipient; Y. Li, Cubist: Investigator, Grant recipient; S. Reed, Cubist: Investigator, Grant recipient; V. Fowler Jr, Cubist: Grant Investigator, Grant recipient
Poster Abstracts
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OFID 2015:2 (Suppl 1)
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S235
