1101. Carbapenem-resistant Enterobacteriaceae Bloodstream Infections in Patients with Hematologic Malignancies
Session: Poster Abstract Session: Infections in Hematopoietic Stem Cell Transplant and Cancer Chemotherapy Recipients
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Carbapenem-resistant Enterobacteriaceae (CRE) are endemic in New York hospitals and emerging elsewhere.  Although patients with hematologic malignancies are at increased risk of infection with Enterobacteriaceae, CRE bloodstream infections (BSIs) in this population have not been well described.

Methods: Laboratory and clinical records were reviewed to identify patients with a hematologic malignancy and CRE bloodstream isolate from July 2007-December 2010.  Demographics, malignancy status, comorbidities, healthcare exposures, treatments and outcomes were recorded.  Antimicrobial susceptibility testing was performed on the first bloodstream CRE isolate from each patient using Vitek 2 and Etest.  Modified Hodge test and PCR were used to detect carbapenemase production and the blaKPC gene, respectively.

Results: Eighteen patients with hematologic malignancy developed CRE BSI, of which 15 were due to Klebsiella pneumoniae.  Six patients were hematopoietic stem cell transplant recipients, of which 5 were allogeneic, and all had neutropenia or graft-versus-host disease.  The remaining 12 patients had acute leukemia (8), lymphoma (3), or myeloma (1).  A source of BSI, most commonly the gastrointestinal tract, was identified in 9 patients.  Seven patients had been in an intensive care unit and 16 had received antimicrobial therapy within the previous 30 days, of which only 4 had received a carbapenem.  Thirteen patients were neutropenic and 16 met systemic inflammatory response syndrome criteria.  Only one patient received empirical therapy with an active antimicrobial agent.  Of patients who eventually received an active agent, a median of 55 hours elapsed between blood culture collection and receipt of the agent.  Ten (56%) patients died during hospitalization and all deaths were related to CRE BSI.  Eight patients remained bacteremic at death.  All isolates were resistant to piperacillin-tazobactam, ceftazidime, and meropenem.  The majority were susceptible to polymyxin B, tigecycline and amikacin.  Of 16 isolates tested, 14 produced carbapenemase and possessed the blaKPC gene.

Conclusion: CRE BSIs are associated with significant delays in effective antimicrobial therapy and high mortality in patients with hematologic malignancy.


Subject Category: O. Transplant infectious diseases

Michael J. Satlin, MD1,2, David P. Calfee, MD1,2, Kathy A. Fauntleroy, MASCP2, Stephen Jenkins, PhD1,2, Barry Kreiswirth, PhD3 and Thomas J. Walsh, MD, FIDSA1,2, (1)Weill Cornell Medical College, New York, NY, (2)New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, (3)Public Health Research Institute, Newark, NJ

Disclosures:

M. J. Satlin, None

D. P. Calfee, None

K. A. Fauntleroy, None

S. Jenkins, None

B. Kreiswirth, None

T. J. Walsh, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.