198. Improving the Outcomes of Cancer Patients with Multidrug-Resistant Gram Negative Rods Bloodstream Infections
Session: Poster Abstract Session: Catheter-associated BSIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA poster 2FINAL.pdf (212.5 kB)
  • Background: Bloodstream infections (BSIs) caused by multidrug-resistant gram negative rods (MDR-GNRs) are an increasing healthcare problem worldwide, especially in immunocompromised patients. Early diagnosis and adequate and prompt therapy have great impact in the clinical outcome of these patients.

    Objectives: To improve the clinical outcomes of cancer patients with MDR-GNR BSI through the initiation of adequate, prompt and early antimicrobial therapy. The goal of this process was to decrease the timeframe from final susceptibility of blood culture to the initiation of adequate therapy.

    Methods:  MDR-GNRs were defined by presence of ESBL or resistance to ≥ 3 of 4 groups (3rd-4th generation cephalosporins, carbapenems, piperacillin/tazobactam and/or quinolones). Resistance to carbapenems alone was also a criterion for MDR-Pseudomonas.

    Since July 15, 2012, we have started the following quality improvement (QI) process: a) All GNR BSI results reported by microbiology laboratory were checked daily by an Infection Preventionist (IP); b) The IP notified the Infectious Diseases (ID) team members when a patient with a MDR-GNR BSI was identified; c) An ID physician/team member notified the primary team of the MDR-GNR BSI by email; d) The primary team decided whether or not to place an online ID consultation request; and e) A system was developed to prospectively collect data. As a control group, we retrospectively reviewed all MDR-GNR BSI cases from Jan’10 to Jul’12.

    Results:

     

    Pre CS&E (193)

    Post CS&E (93)

    p value

     

    ID

    Non-ID

    ID

    Non-ID

     

    Cases

    117 (61%)

    76 (39%)

    73 (78%)

    20 (22%)

    <0.01

    Active therapy

    113 (97%)

    51 (67%)

    70 (96%)

    9 (45%)

    <0.001

    Time from final susceptibility to adequate therapy

    15h41’

    37h15’

    8h36’

    86h49’

    <0.01

    Infection-related

    ICU admission

    19 (16%)

    16 (21%)

    3 (4%)

    4 (20%)

    0.049

    Infection-related

    Mortality

    18 (15%)

    21 (28%)

    5 (7%)

    7 (35%)

    0.046

    Conclusion: This process has increased the number of early ID consultations and reduced the timeframe from the report of the final susceptibility to initiation of active therapy. This QI intervention has a favorable impact on clinical outcome, playing a role in the reduction of both infection-related ICU admission and infection-related mortality in our cancer patients.

    Nobuyoshi Mori, MD1,2, Aline El Zakhem, MD1, Polly Williams, MT(ASCP), CIC1, Sherry Cantu, MPH1, Jeffrey J. Tarrand, MD3, Issam Raad, MD1, Roy Chemaly, MD, MPH1 and Javier A. Adachi, MD, FIDSA1, (1)Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, (2)Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, (3)Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX

    Disclosures:

    N. Mori, None

    A. El Zakhem, None

    P. Williams, None

    S. Cantu, None

    J. J. Tarrand, None

    I. Raad, American Medical Systems: inventor/co-inventor, Licensing agreement or royalty
    Cook: Speaker's Bureau, Grant recipient and Licensing agreement or royalty
    ECP: stock ownership, stock ownership
    Great Lakes Pharmaceuticals: stock options, stock options
    Inventive Protocol, Inc.: stock ownership, stock ownership
    Medline: inventor/co-inventor, Licensing agreement or royalty
    TyRx: inventor/co-inventor, Licensing agreement or royalty

    R. Chemaly, None

    J. A. Adachi, Optimer Phamaceuticals, Inc: Grant Investigator, Research grant

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