Risk Factors for Extended-Spectrum Beta-Lactamase Infection and Evaluation of Carbapenem Use Patterns and Appropriateness in a County Hospital Setting
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.
P. Chan, None
E. Santos, None
A. Jeng, None
See more of: Poster Abstract Session