1608. Risk Factors and Mortality in Carbapenem Resistant Gram Negative Bacteremias: A Retrospective Analysis from a Tertiary Health Care Setting in India
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Infections with multi drug resistant gram negative bacteria are a major concern in tertiary care hospitals in India. Blood stream infections with such organisms lead to increased duration of hospitalization, morbidity and mortality. The lack of new antibiotics for gram negative infections portends a bleak future.

Methods: A retrospective analysis of adults >18 years with first episode of bacteremia due to carbapenem resistant gram negative bacteria, from Jan 2011 to March 2013 was performed, to evaluate risk factors and mortality. The primary outcome was mortality.

Results: 55 cases of blood stream infections with carbapenem resistant gram negative bacteria were recognized. Total positive blood cultures for the same time period were 741. Carbapenem resistant Klebsiella pneumoniae was isolated in 24/55(43.63%) patients, followed by MDR Acinetobacter baumanii in 18/55(32.72%), Pseudomonas aeruginosa in 6/55 (10.9%), Escherichia coli 4/55 (7.27%) and MDR Enterobacter in 3/55 (5.45%).

Mortality was 50.9% (28/55). The common risk factors were chronic hemodialysis, chronic liver disease, malignancy and multiple hospitalizations. Most of the carbapenem resistant bacteria were sensitive to colistin, although MIC determination was not done. Most of the blood stream infections due to multidrug resistant gram negative bacteria occurred beyond the first week of hospitalization.

Conclusion: Conclusions:  1. Mortality due to carbapenamase producing bacteria is high.
              2. Resistance to colistin was not observed.
              3. Klebsiella pneumoniae appears to be the most common carbapenamase producing organism in our setting.

References:
1.      Predictors of Mortality in Bloodstream Infections Caused by Carbapenemase-Producing K. pneumonia: Importance of Combination Therapy. Clinical Infectious Diseases 2012;55(7):943-50

Purnima Parthasarathy, MBBS, American Board Certified in Internal Medicine and Infectious Diseases, Infectious Diseases, Apollo Hospitals, Bangalore, India

Disclosures:

P. Parthasarathy, None

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