Program Schedule

434
Prevalence, Risk Factors, and Outcomes of Bacteremia Caused by Carbapenem-resistant Enterobacteriaceae in Neutropenic Patients with Hematologic Malignancies

Session: Poster Abstract Session: Transplant Infectious Diseases
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • Poster_CRE in neutropenic patients_IDWeek 2014.pdf (743.1 kB)
  • Background: Neutropenic patients with hematologic malignancies rely on immediate, active antimicrobial therapy to combat bacterial infections, and thus are uniquely threatened by multidrug-resistant bacteria. Carbapenem-resistant Enterobacteriaceae (CRE) have emerged worldwide and are resistant to nearly all antimicrobial agents, but their impact on neutropenic patients is unknown. 

    Methods: In order to assess the prevalence, risk factors, and outcomes of CRE bacteremia in neutropenic patients with hematologic malignancies, we reviewed all bloodstream infections (BSIs) from 2008-2012 in this population at New York-Presbyterian Hospital/Weill Cornell and Memorial Sloan Kettering Cancer Center and conducted a case-control study. For each case of CRE BSI, three controls matched by study site and year were randomly selected among BSIs caused by other pathogens. 

    Results: CRE caused 4.8% of Gram-negative bacteremias and 2.1% of all BSIs. Of the 42 episodes of CRE bacteremia, 31 (74%) were in patients with acute leukemia, 15 (36%) were in allogeneic stem cell transplant recipients, and 26 (62%) were in patients without prior carbapenem exposure. Independent risk factors for CRE bacteremia were exposure to β-lactam/β-lactamase inhibitors (BL-BLI; odds ratio [OR] = 3.7; P = 0.01) and trimethoprim-sulfamethoxazole (TMP-SMX; OR 6.0; P = 0.007), glucocorticoid use (OR 5.3; P = 0.001), and having a prior culture that grew CRE (OR 19.2; P = 0.01). Patients with CRE bacteremia were less likely than controls to receive active empirical therapy (14% vs. 56%, P < 0.001) and had longer delays until receipt of active therapy (median hours: 52 vs. 5, P < 0.001). They also had higher 30-day (51% vs. 25%, P = 0.001) and BSI-related (49% vs. 16%, P < 0.001) mortality rates, with a median of 3 days from bacteremia onset until death. The six cases of CRE bacteremia that received active empirical therapy had a lower 30-day mortality rate than that of the 36 others that did not (17% vs. 58%; P = 0.09).

    Conclusion: CRE are emerging as lethal causes of bacteremia in neutropenic patients with hematologic malignancies. Exposures to BL-BLI, TMP-SMX, and glucocorticoids and having a prior culture that grew CRE are risk factors for CRE bacteremia in this population. New strategies are needed to shorten the delay until administration of CRE-active agents and mitigate this emerging threat.

    Michael J. Satlin, MD, MS1, Nina Cohen, PharmD2, Kevin C. Ma, MD3, Zivile Gedrimaite4, Thomas J. Walsh, MD, FIDSA5 and Susan K. Seo, MD6, (1)Internal Medicine/Infectious Diseases, Weill Cornell Medical College, New York, NY, (2)Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, (3)Internal Medicine, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, (4)Infectious Diseases Service, Memorial Sloan-Kettering Cancer Center, New York, NY, (5)New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, (6)Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY

    Disclosures:

    M. J. Satlin, None

    N. Cohen, None

    K. C. Ma, None

    Z. Gedrimaite, None

    T. J. Walsh, None

    S. K. Seo, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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