440. Epidemiologic Study of the Spectrum of Bloodstream Infections (BSIs) in Acute Myeloid Leukemia (AML) Patients Over an Eight-Year Period
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: BSIs are an important cause of morbidity and mortality in AML patients (pts) with crude mortality rates exceeding 40% in some reports. Periodic shifts in the spectrum of BSIs have taken place in neutropenic pts with cancer over the decades. Prior to the mid-1980’s, gram negative bacilli (GN) predominated but since that time, gram positive (GP) bacteria have become the most common isolated pathogens. In addition, antimicrobial susceptibility patterns have changed with increasing rates of resistance. The purpose of this study was to determine institution-specific distribution of pathogens and susceptibilities (S) to antimicrobial (ABX) agents utilized in this setting.
Methods: Two hundred eighty-five documented BSIs were identified through a retrospective analysis of 822 AML patients undergoing induction chemotherapy from January 2000 through December 2007. Infection rate was calculated and spectrum of BSIs was collected and trended. Susceptibility patterns for primary ABX were analyzed. ABX prophylaxis was not routinely utilized until January 2005 when levofloxacin became our standard.
Results: A 25% marked reduction of total BSIs per 1000 AML induction days was noted with lowest incidence occurring in 2005. GP organisms predominated over the 8 year period with GN’s accounting for < 15% of all BSIs in 2005, however, the GN ratio has increased over the last 2 years (~30%) with fluoroquinolone resistant EColi emerging as the primary pathogen. The most common organisms identified included: coagulase-negative staphylcocci, streptococcus, enterococcus, EColi, staphylcoccus aureus, and Klebsiella. S of BSI isolates to standard neutropenic fever antimicrobials remained unchanged.
Conclusion: The determination of institution-specific distribution of pathogens and S patterns has provided guidance in the selection of the most appropriate antimicrobial(s) and has resulted in modifications to our current practice in this high risk pt population.
Tim George, PharmD1, John Greene, MD2, K. Leigh McFarland, PharmD3, Rod Quiltz, PharmD, BCOP1, Dawn Ruge, BS1, Ramon Sandin, MD4, Gene Wetzstein, PharmD1 and  G. A. Wetzstein,
Astellas Pharmaceuticals Role(s): Consultant, Speaker's Bureau, Received: Speaker Honorarium, Consulting Fee.
Cubist Pharmaceuticals Role(s): Grant Investigator, Received: Research Support.
Schering Plough Pharmaceuticals Role(s): Consultant, Speaker's Bureau, Received: Speaker Honorarium, Consulting Fee.
K. McFarland, None..
T. J. George, None..
D. Ruge, None..
R. L. Sandin, None..
J. N. Greene, None. 
R. Quiltz,
Astellas Role(s): Scientific Advisor (Review Panel or Advisory Committee).
Wyeth Role(s): Scientific Advisor (Review Panel or Advisory Committee).
Ortho McNeil Role(s): Scientific Advisor (Review Panel or Advisory Committee)., (1)Moffitt Cancer Center, Tampa, FL, (2)H. Lee Moffitt Cancer Center, Tampa, FL, (3)University of Kansas Hospital, Kansas City, KS, (4)Hematopathology and Laboratory Medicine, Moffitt Cancer Center, Tampa, FL