Program Schedule

369
Outcomes of Patients with Carbapenem-Resistant Enterobacteriaceae

Session: Poster Abstract Session: Multidrug-resistant Organisms: Epidemiology and Prevention
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • 369_IDWPOSTER.pdf (503.7 kB)
  • Background: In an era of increasing antibiotic resistance, the emergence of Carbapenem-Resistant Enterobacteriaceae (CRE) poses a serious threat to public health given the limited treatment options and high mortality rate. 

    Methods: This is a single center, retrospective, cohort study that evaluated characteristics and outcomes of adult patients hospitalized from July 1, 2010 through June 30, 2013 with their first diagnosis of CRE as confirmed via the Modified Hodge Test. 

    Results: 27 cases of CRE were identified during the study period.  18 were deemed to have a true infection while 9 were asymptomatic colonizers.  Klebsiella pneumoniae was the causative organism in all but one case of Klebsiella oxytoca.  The mean time to CRE diagnosis was 18 days and the mean length of hospital stay was 37 days.  41% of patients were admitted from home, 37% from an outside hospital (OSH), and 22% from a long term care facility.  Patients transferred from an OSH had an increased mortality (p 0.0269).  Of those admitted from home, 45% were diagnosed with early infection (positive culture in the first 48 hours).  Of those with early infection admitted from home, 80% had been hospitalized during the 90 days before CRE diagnosis.  Infection was most common in the urine and respiratory tract.  Overall mortality rate for patients with an active infection was 44.4%.  A higher mortality rate was seen in patients with pulmonary infections (p 0.0003) and patients who had isolation of MDR Pseudomonas 6 months prior to CRE (p 0.0172).  81.4% of patients received antibiotics within 90 days prior to CRE diagnosis.  The most common antibiotics with activity against gram negatives that patients were exposed to were: piperacillin/tazobactam (37%), fluroquinolones (33.3%), and carbapenems (29.6%).  For patients with true infection, 33.3% were given combination therapy with at least 2 of the following: amikacin, colistin, tigecycline, and a carbapenem.  83% of patients who received combination therapy died (p 0.0037).  76.2% of tested isolates were susceptible to colistin, 62.5% to tigecycline, 59.3% to amikacin, and 11.1% to gentamicin. 

    Conclusion: Infections due to CRE are associated with a prolonged length of stay and result in significant mortality in spite of combination therapy.  We observed a particularly high mortality in patients with CRE pneumonia.

    Jillian Raybould, MD1, Kelly Carpenter, MD2, Nandita Mani, MD2, Richard Teran, MPH3, Mashashi Waga4, Princy N. Kumar, MD5 and Joseph G. Timpone, MD6, (1)Internal Medicine, Georgetown University Hospital, Washington, DC, (2)Georgetown University School of Medicine, Washington, DC, (3)Division of Infectious Diseases and Travel Medicine, Georgetown University Hospital, Washington, DC, (4)Pathology and Laboratory Medicine, Medstar Washington Hospital Center, Washington, DC, (5)Georgetown University Medical Center, Washington, DC, (6)Infectious Diseases, Georgetown University Hospital, Washington, DC

    Disclosures:

    J. Raybould, None

    K. Carpenter, None

    N. Mani, None

    R. Teran, None

    M. Waga, None

    P. N. Kumar, Janssen : Grant Investigator and Speaker's Bureau, Consulting fee, Grant recipient, Research grant, Research support and Speaker honorarium
    GSK: Grant Investigator and Shareholder, Grant recipient, Research grant and Research support
    Merck: Grant Investigator and Shareholder, Grant recipient, Research grant and Research support
    ViiV Healthcare: Consultant and Speaker's Bureau, Speaker honorarium
    Phizer: Shareholder, stock shareholder
    Johnson & Johnson: Shareholder, stock shareholder
    Gilead : Shareholder, stock shareholder

    J. G. Timpone, None

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