1421. The Impact of Resistance on Outcomes in Klebsiella pneumoniae Blood Stream Infection in Hematopoietic Stem Cell Transplant (HSCT) Recipients
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Posters
  • COBER poster layout KK 10-8.pdf (785.5 kB)
  • Background: Bacterial blood stream infections (BSI) are associated with substantial mortality in recipients of HSCT. Since 2006, isolates of Klebsiella pneumoniae (Kp) have increasingly been reported to harbor extended spectrum beta-lactamases (ESBL) or carbapenem resistance in our institution. We describe characteristics and outcomes in HSCT recipients with BSI due to highly drug resistant Kp compared with less resistant Kp.

    Methods: Retrospective analysis of all Kp BSI in HSCT recipients in a single center in Cleveland, OH during a 7-year period from 1/1/2005 to 12/31/2011.

    All patients with a history of either autologous or allogeneic HSCT with a blood culture positive for Kp were identified. Bacterial identification was confirmed using standard automated methods.

    Clinical parameters were recorded for analysis. Multi-drug resistant (MDR) isolates were defined as those harboring ESBL enzymes or carbapenem resistance.

    Primary outcome was a combined endpoint defined as 30-day mortality from onset of bacteremia or recurrence of Kp BSI defined as a positive blood culture collected 7 days or more from the date of initial clearance.

    Results: 42 patients with Kp BSI were identified among HSCT recipients. Ten patients harbored MDR isolates while 32 patients had non-MDR Kp BSI.

    By univariate analysis, no significant differences were found in baseline characteristics between the groups except longer total duration of neutropenia (p 0.0259) was more common among MDR isolates.

    By Kaplan-Meier analysis, MDR Kp BSI was highly associated with the combined endpoint of 30-day mortality or recurrence of Kp BSI (Log-Rank 11.38, p 0.0007).  Four patients with MDR Kp BSI reached the combined endpoint, as opposed to only 1 patient with non MDR Kp BSI.

    A proportional hazards model incorporating the presence of MDR Kp BSI and total duration of neutropenia showed MDR isolates to still be highly associated with the combined endpoint (HR 16.8, 95%CI 2.4 – 332, p 0.004).

    Conclusion: BSI due to MDR Kp in HSCT recipients may be associated with increased mortality or recurrence of Kp BSI. Larger prospective studies are required to confirm this association.

    Juan N Kattan, MD1, Matt Kalaycio, MD2, David van Duin, MD, PhD1 and Eric Cober, MD1, (1)Infectious Disease, Cleveland Clinic, Cleveland, OH, (2)Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH

    Disclosures:

    J. N. Kattan, None

    M. Kalaycio, None

    D. van Duin, Pfizer: Scientific Advisor, Consulting fee
    Astellas: Speaker's Bureau, Speaker honorarium

    E. Cober, None

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