Program Schedule

1801
Organism profile and antimicrobial resistance patterns of healthcare-associated bloodstream infections in oncology settings

Session: Oral Abstract Session: New Insights into the Prevention and Control of MDR GNR
Saturday, October 11, 2014: 2:15 PM
Room: The Pennsylvania Convention Center: 109-AB

Background: Recent antimicrobial resistance (AR) data are lacking from inpatient oncology (ONC) settings to guide infection prophylaxis and treatment recommendations.  We describe central line-associated bloodstream infection (CLABSI) pathogens and AR patterns reported from ONC locations to the CDC's National Healthcare Safety Network (NHSN).

Methods: CLABSIs reported to NHSN from 2009-2012 from ONC and non-oncology (NONC) inpatient locations in the same hospitals were compared.  Proportions were compared with Χ2 tests and CLABSI rates (per 1000 central-line days) with Poisson regression.

Results: ONC locations in 220 hospitals reported 5,948 CLABSIs due to 6,615 organisms.  These hospitals reported 18,302 CLABSI due to 20,392 organisms from NONC locations.  The most common ONC location CLABSI organisms were coagulase-negative staphylococci (CNS, 16.0%), Escherichia coli (11.5%) and Enterococcus faecium (10.2%) (Table).  Fluoroquinolone resistance (FQ-R) was more common among E. coli CLABSIs in ONC than NONC locations (51.6% vs 31.7% of isolates tested, P<0.0001).  Among organism/AR classes evaluated in ONC location CLABSIs, only FQ-R in E. coli increased significantly between 2009–10 and 2011–12 (45.1% vs 55.3%, P=0.009).  Furthermore, rates of FQ-R E.coli and vancomycin-resistant Enteroccocus (VRE) faecium CLABSI (per 1000 central-line days) were significantly higher in ONC compared to NONC locations (FQ-R E. coli rate ratio [RR] 5.5, 95% confidence interval [CI] 4.7–6.4; VRE faecium RR 2.0, 95% CI 1.8–2.3).

Conclusion: VRE faecium and FQ-R E. coli are significant CLABSI pathogens in ONC units, and rates of E. coli FQ-R increased recently, likely a result of widespread FQ use (e.g., prophylaxis).  AR was higher in ONC than in NONC locations for some but not all pathogens.  Guidelines for antimicrobial use in ONC patients may need to account for changes in AR patterns over time.

 

CLABSI Organism and AR class

Oncology Rank

Oncology, N=6,615

Non-oncology, N=20,392

P for %AR

n (%)

% AR

n (%)

% AR

CNS

1

1058 (16.0)

 

3895 (19.1)

 

 

E. coli

2

758 (11.5)

 

859 (4.2)

 

 

 

FQ-R

 

 

51.6

 

31.7

<0.001

E. faecium

3

677 (10.2)

 

1225 (6.0)

 

 

 

VRE

 

 

80.7

 

82.7

0.74

Staphylococcus aureus

4

623 (9.4)

 

2727 (13.4)

 

 

 

MRSA

 

 

41.2

 

46.7

0.02

Klebsiella oxytoca/pneumoniae

5

614 (9.3)

 

1703 (8.3)

 

 

 

FQ-R

 

 

10.0

 

15.0

0.003

 

Isaac See, MD, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, Alison Freifeld, MD, Internal Medicine, University of Nebraska Medical Center, Omaha, NE and Shelley S. Magill, MD, PhD, Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

I. See, None

A. Freifeld, None

S. S. Magill, None

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