1408. Multidrug resistant gram-negative bacteremia in residents from long-term care facilities in Singapore
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Posters
  • IDWeek poster_MDR GN LTCF_v2.pdf (1.2 MB)
  • Background: The prevalence of multidrug resistant(MDR) gram-negative(GN) bacteria is increasing globally in healthcare facilities including long-term care facilities(LTCF) and the wider community. The contribution of LTCFs to MDR GN infections in Asia is not well described. The aim of this study is to determine the association between residence in LTCFs and MDR GN bacteremia. Methods: A retrospective cohort of patients, hospitalized at the 1400 bed Tan Tock Seng Hospital or the 1600 bed Singapore General Hospital in Singapore, included those with first episode of bacteremia of the following organisms, Enterobacteriaceae, Pseudomonas aeruginosa or Acinetobacter baumannii and evidence of sepsis using SCCM criteria. Patients were identified from the hospital laboratory database. The primary outcome was MDR status, among GN bacteria. Patients with MDR and susceptible GN bacteremia were compared. Demographic and host characteristics including residence in LTCFs, were analyzed in a multivariable logistic regression model. Two separate analysis, of patient cohorts with bacteremia in the first 48 hours and after 48 hours of hospitalization as well as a third pooled analyses of all admissions, were performed. Results: There were 675 episodes of healthcare associated and hospital acquired GN bacteremia over the 31 month period. Residence in a LTCF was an independent risk factor for MDR GN bacteremia (OR 2.7, 95%CI 1.4-5.0, p<0.01). This risk persisted beyond the first 48 hours of hospitalization (OR 3.5, 95%CI 1.4-9.0, p=0.01), typically nosocomial acquisition. In the pooled analyses, prior positive culture (within 90 days of event)(OR 1.9, 95%CI 1.3-2.7, p<0.01) and antibiotic use (within 30 days of event)(OR 1.7, 95%CI 1.2-2.4, p=0.01) were also risk factors for MDR GN bacteremia. Patients from LTCFs, were less likely to receive appropriate empirical antibiotic therapy (31.4% versus 58.8%, p<0.01) and had a higher 30-day mortality (39.2% versus 21.5%, p<0.01). Conclusion: Residence in a LTCF is an independent risk factor for MDR GN bacteremia in Singapore hospital patients with sepsis. Infection prevention and control strategies need to expand to include the growing LTCF population in large Asian cities if we are to attempt to contain MDR GN bacteria.
    Indumathi Venkatachalam, MBBS1,2, Li Yang Hsu, MBBS3, Dale Fisher, FRACP3, David Lye, MBBS4,5, Moi Lin Ling, MBBS, FRCPA, CPHQ, MBA6, Paul Ananth Tambyah, MD, FSHEA7 and Trish M. Perl, MD, MSc, FIDSA, FSHEA8,9,10,11, (1)Infectious Diseases, National University Hospital, Singapore, Singapore, Singapore, (2)Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (3)National University Hospital, Singapore, Singapore, (4)Tan Tock Seng Hospital, Singapore, Singapore, (5)Communicable Diseases Centre, Tan Tock Seng Hospital, Singapore, Singapore, (6)Infection Control, SINGAPORE GENERAL HOSPITAL, Singapore, Singapore, (7)Dept of Med,Div of ID, National University of Singapore, Singapore, Singapore, (8)Johns Hopkins Medical Institutions, Baltimore, MD, (9)Johns Hopkins Health System, Baltimore, MD, (10)Johns Hopkins University School of Medicine, Baltimore, MD, (11)Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD

    Disclosures:

    I. Venkatachalam, None

    L. Y. Hsu, None

    D. Fisher, None

    D. Lye, None

    M. L. Ling, None

    P. A. Tambyah, None

    T. M. Perl, Merck: Grant Investigator, Research grant
    Hospira: Board Member, Consulting fee

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 17th with the exception of research findings presented at the IDWeek press conferences.