383. Length of Stay and Epidemiology of Multidrug-Resistant (MDR) Gram Negative Bloodstream Infections (GNBSIs) in Older Adults
Session: Poster Abstract Session: Gram Negative Infection - Epidemiology and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Background: 

Bloodstream infections  due to multidrug-resistant gram-negative pathogens (MDRGN BSI) account for increasing hospital morbidity and mortality as well as enormous hospital costs. Despite increasing incidence of these infections in older adults, scant data are available regarding the impact on of these infections on duration of hoispitalization in older adults.

Methods: 

A retrospective cohort study was performed at the Detroit Medical Center on older adults (age>65 years) with MDR GNBSIs from Jan 2005 to Aug 2009. MDR GNBSIs included patients with bloodstream infections  due to 1) extended-spectrum ß lactamase-producing organisms (ESBLs)   2) Acinetobacter sp. and 3 ) carbapenem-resistant Enterobacteraciae  (CREs).  Patient information collected included demographics, functional status, comorbid conditions, antibiotic exposure, surgeries, and length of stay from date of positive culture to discharge.

Results: 

The cohort included 189 older adults with bloodstream MDRGNIs .The  mean age was  77.2±7.78,55%  were female and 82% African-American.  Median hospital stay after positive culture was 8 days (IQR 4-14 days). Bivariate variables associated wtih increased LOS are shown in the Table. Logistic regression identified history of MI (OR= 1.46, 95%CI = 1.06-2.04, p=0.024) and receipt of TPN (OR=1.56, 95% CI = 1.13-2.18, p=0.008) as  independent risk factors for increased LOS.

Table: Biviariate predictors associated with increased duration of hospitalization following MDRGN BSI

Risk factor

Variable present, median LOS (IQR)

Variable absent, median LOS (IQR)

            p value

MI

12 (6-19)

7.5 (4-12)

0.01

CHF

9 (5-17)

7 (4-12)

0.04

TPN

9 (6-22)

8 (4-13)

0.01

Diabetes with end-organ damage

10 (5-17)

7.5 (4-14)

0.06

Recent surgery

10 (5-17.5)

8 (4-13)

0.06

Conclusion: 

Among older adults with MDRGN BSIs the median attributable duration of hospitalization associated with history of MI was 3.5 days and receipt of TPN was 4.5 days.  


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Teena Chopra, MD1, Andrew Prout, BA2, Dror Marchaim, MD1, Paul Johnson, BS2, Heather Bowman, BS2, Jennifer Veltman, MD1, Ylinne Lynch, MD1, Khawar Chaudhry, BS1, Chris Bogan1, Blunden Christopher1, Asma Hasan1, Chris Kosmidis, MD1 and Keith Kaye, MD, MPH, FIDSA1, (1)Detroit Medical Center/Wayne State University, Detroit, MI, (2)Wayne State University School of Medicine, Detroit, MI

Disclosures:

T. Chopra, None

A. Prout, None

D. Marchaim, None

P. Johnson, None

H. Bowman, None

J. Veltman, None

Y. Lynch, None

K. Chaudhry, None

C. Bogan, None

B. Christopher, None

A. Hasan, None

C. Kosmidis, None

K. Kaye, None

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