825. Outcomes in Patients with Carbapenem Resistant Klebsiella pneumoniae (CRKP) Bacteremia
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 9, 2015
Room: Poster Hall
Background:   Infections caused by CRKP pose an important challenge to clinicians as conventional therapy often fails, resulting in high attributable mortality and economic burden. This study aims to describe the epidemiological characteristics and clinical outcomes associated with acquisition of CRKP bloodstream infections.

Methods: A retrospective, observational study was conducted to evaluate adult patients (age ≥ 18 years) who had a documented CRKP blood-stream infection between January 2009 and September 2014. The following clinical outcomes were assessed: 30-day mortality, infection-related mortality, microbiological cure, length of stay, and intensive care unit length of stay. 

Results: Twenty-four patients had bacteremia with a median Pitt bacteremia score of 3 (Interquartile range (IQR), 2-5). The most common source of infection was intra-abdominal (14, 58.3%), followed by urine and lung (both 3, 12.5%).  Half of patients had a Charlson Comorbidity Index greater than 5, indicating a high baseline probability for overall mortality.  Despite primary source control (90.9%), the overall infection related mortality and all-cause 30-day mortality rates were 41.7% and 42.9%, respectively.  Colistin and aminoglycoside therapy were associated with suboptimal efficacy and higher infection-related mortality rates, 42% and 50%, respectively.  When comparing combination therapy to monotherapy, no significant differences were observed in 30-day or infection-related mortality. Furthermore, source of bacteremia did not significantly impact mortality endpoints.  Approximately one in five patients had recurrent infections. Solid organ transplant recipients had a lower rate of 30-day mortality in comparison to non-transplant recipients (0% vs 56.3%, P= 0.045). 

Conclusion:  CRKP bacteremia was associated with high mortality and recurrence rates. With limited antimicrobial agents, it is a challenge for clinicians to identify optimal treatment.  Actions should be taken promptly to (1) recognize CRKP blood-stream infections, (2) select effective antimicrobial treatment options and (3) prevent transmission through infection control measures.

Aabha Jain, MD1, Samantha Rosenthal, PharmD2, Dong Heun Lee, MD1 and Tiffany Bias, PharmD, BCPS, AAHIVP2, (1)Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, (2)Pharmacy, Hahnemann University Hospital, Philadelphia, PA

Disclosures:

A. Jain, None

S. Rosenthal, None

D. H. Lee, None

T. Bias, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.