Program Schedule

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Risk Factors for Extended-Spectrum Beta-Lactamase Infection and Evaluation of Carbapenem Use Patterns and Appropriateness in a County Hospital Setting

Session: Poster Abstract Session: Multidrug-resistant Organisms: Epidemiology and Prevention
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Increasing reports of extended-spectrum β-lactamase (ESBL) production among Enterobacteriaceae have resulted in increased usage of carbapenems (CRBs). However, increased utilization of any antibiotic is associated with accelerated bacterial resistance to that antibiotic class. The aim of the present study was to determine: (1) risk factors for infection with ESBL-producing Enterobacteriaceae and (2) patterns and appropriateness of CRB use.

Methods: Patients hospitalized at UCLA-Olive View Medical Center from years 2010-2013 during the months of October to December were evaluated if they received at least 1 dose of CRB therapy during their hospital stay. ESBL infections were characterized as community-acquired, healthcare-associated, or nosocomial. CRB usage was judged as appropriate if it met any of the following: 1) positive ESBL culture, 2) history of prior ESBL culture, 3) Active pseudomonal infection sensitive to CRB, 4) Failure of empiric antibiotics, 5) other appropriate criteria, e.g. necrotizing pancreatitis.

Results: Of 255 total patients, 69 (27%) had an ESBL-positive culture. The majority were isolated from the urinary tract (74%), followed by blood (13%) and wound sites (5%). The majority of ESBL infections were health-care associated (76%), vs. community acquired (14%). ESBL-positive patients were more likely to be female (72% vs 46%, p=0.01), on hemodialysis (HD) (11% vs 7%, p=0.001), to have a history of previous UTI (57% vs. 35%, p=0.002), or previous ESBL infection (43% vs. 22%, p=0.001) and to have antibiotic exposure in the previous 90 days (68% vs. 49%, p=0.006). Only 1 of 69 (1%) patients with ESBL infection had no documented past medical history.

Only 51% of patients were judged to have received CRBs appropriately. There was no difference between ESBL patients and non-ESBL patients in terms of duration of hospital stay (13 vs. 11 days, p=0.636), ICU admission rate (26% vs. 36%, p=0.135) or in-hospital mortality (9% vs. 12%, p=0.412).

Conclusion: ESBL infection was rare in the absence of specific risk factors (previous UTI, antibiotic exposure, history of ESBL). Data from this study may be used in an evidence-based approach for empiric CRB use to decrease inappropriate usage and bolster antibiotic stewardship efforts.

Henry Su, MD1, Julianne Joo, PharmD2, Patrick Chan, PharmD, PhD3, Eloise Santos, PharmD3 and Arthur Jeng, MD4, (1)Infectious Diseases, UCLA Multi-Campus/Cedars Sinai, Los Angeles, CA, (2)Pharmacy, Olive View-UCLA Medical Center, Sylmar, CA, (3)Pharmacy Practice and Administration, Western University of Health Sciences, Pomona, CA, (4)Infectious Diseases, Olive View-UCLA Medical Center, Sylmar, CA

Disclosures:

H. Su, None

J. Joo, None

P. Chan, None

E. Santos, None

A. Jeng, None

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