368. Incidence of Methicillin-Resistant Staphylococcus aureus in Bacterial Isolates Among Patients with Febrile Neutropenia
Session: Poster Abstract Session: MRSA, MSSA, Enterococci
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background:  Febrile neutropenia (FN) is associated with up to a 10% mortality rate; however, an infectious source is identified in only 20 to 30% of cases.  The Infectious Diseases Society of America (IDSA) clinical practice guidelines recommend vancomycin for empiric therapy when patient-specific risk factors are present, and especially for treatment in a hospital with a high rate of Methicillin-Resistant Staphylococcus aureus (MRSA) endemicity.  Grady Health System (GHS) treats a significant number of HIV-infected patients and patients with HIV-associated cancers.  Approximately 50% of all Staphylococcusisolates hospital-wide are methicillin-resistant, and thus vancomycin is frequently administered as part of empiric therapy in FN episodes.  The purpose of the study is to determine incidence of MRSA in bacterial isolates among FN episodes in order to assess appropriateness of vancomycin for empiric therapy.

Methods:  A retrospective chart review from November 1, 2010 to May 31, 2012 was performed at GHS for patients 18 years of age or older with an ANC < 500 cells/mm3. Patients with fever and neutropenia were then identified.  Fever, risk factors, cultures, microbiologic isolates and antibiotic susceptibilities were recorded and analyzed.

Results:  Of the 359 neutropenic patients evaluated, 41 patients were included in the study.  The etiology of neutropenia was chemotherapy/malignancy in 16 (40%) patients and HIV in 13 (33%) patients.  There were 25 positive microbiologic cultures, 60% of all cultures were blood cultures, with only one MRSA isolate (4%) in an HIV patient.  Overall, 64% of isolates were gram-negative bacteria.  28% of all positive cultures were multi-drug resistant Klebsiella pneumoniae.  Of the sixteen patients without IDSA-defined patient-specific risk factors indicating the need for empiric vancomycin, 87.5% still received empiric vancomycin.

Conclusion:  The majority of isolated organisms in FN patients at GHS were gram-negative, with only one MRSA positive isolate.  Despite the low incidence of MRSA and lack of consistent indications for addition of vancomycin to empiric antibiotic regimens, vancomycin was empirically ordered in 96% of FN patients.  Accordingly, vancomycin should be prescribed on a case-by-case basis in patients with FN, regardless of institution-specific MRSA endemicity.

Katherine Pleasants, PharmD1, Saira Rab, PharmD, BCPS1, Marjorie Curry, PharmD, BCPS, BCOP1, Jennifer Lafollette, PharmD, BCPS, BCOP1 and Sheetal Kandiah, MD MPH2, (1)Pharmacy, Grady Health System, Atlanta, GA, (2)Medicine, Emory University, Decatur, GA


K. Pleasants, None

S. Rab, None

M. Curry, None

J. Lafollette, None

S. Kandiah, None

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