1812. Differentiating Patients with Multi-Drug Resistant (MDR) Gram-Negative Infections Present at the Time of Hospital Admission (POA) From Those with Susceptible (S) and Extremely-Drug Resistant (XDR) Pathogens
Session: Poster Abstract Session: Resistant Gram-Negative Infections: Epidemiology
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Abstract POA IDSA 2015.pdf (190.8 kB)
  • Background:

    Treatment for MDR Gram-negative bacilli (GNB), defined as extended-spectrum- beta-lactamase-producing enterobacteriaceae (ESBLs) and beta-lactam resistant Pseudomonas aeruginosa, is limited to carbapenems and ceftolozane/tazobactam (CT). Acinetobacter baumannii and carbapenem-resistant enterobacteriaceae (XDR GNB), often require treatment with toxic antibiotics. Differentiating patients at risk for MDR GNB from those with more susceptible (S ) and  those with XDR GNB would allow clinicians to optimize empiric therapy while limiting exposure to broad spectrum and toxic agents. The aims of this study were to identify unique, independent predictors for patients with MDR GNB presenting during the initial 72 hours of admission (POA); and to quantify outcomes independently associated with infections due to MDR GNB. 

    Methods:

    A case-case-control and a retrospective matched cohort study were conducted, including patients with POA bloodstream infection or pneumonia, from 1/1/2010 -12/31/2013. Patients with MDR GNB were matched to patients with S GNB.  A third group of XDR GNB patients were also included.  Independent risk factors for MDR GNB in both models (vs S and vs XDR GNB) were considered unique for POA MDR GNB. The impact of MDR GNB on clinical outcomes was determined in propensity-adjusted analyses. 

    Results:

    The study population included 547 subjects: 190 MDR GNB; 190 S and 167 XDR GNB.  Independent risk factors for MDR GNB, compared to both S and XDR GNB were identified (Table, *).  Mortality rates were 16%, 8% and 19% in the MDR, S and XDR GNB groups.  MDR GNB was associated with increased mortality compared to the S (OR = 3.6, 95% CI =1.1-11.9) but was similar to the XDR GNB group.

    Conclusion:

    Among patients with suspected invasive POA Gram-negative infection, age > 65 years, chronic lung disease and recent surgery, were unique independent risk factors for MDR GNB.

    Table: Independent predictors of MDR GNB vs. comparators (p < 0.05)

    MDR vs S

    MDR vs XDR

    Odds ratio (OR)

    OR

    Age> 65*

    2.9

    2.6

    Recent surgery*

    5.3

    4.0

    Lung disease*

    6.1

    1.9

    Admission not from home

    4.2

    MI

    2.8

    Vascular disease (dz)

    7.1

    Diabetes

    2.1

    Neurologic dz

    11.8

    IVDU

    4.8

    Steroids

    10.8

    Quinolones

    6.2

    Central Line POA

    9.7

    Dementia

    2.8

    Foley POA

    0.5

    Recent hospitalization

    1.6

    Vancomycin

    0.2

    Nader Tashtoush, MD1, Jason Pogue, PharmD2, Bakht Nishan, MD3, Dhafer Salem, MD3, Hamadullah Shaikh, MD3, Madiha Salim, MD3, Amina Pervaiz, MD4, Aditya Kotecha, MD3, Shigehiko Karino, MD5, Sorabh Dhar, MD2 and Keith Kaye, MD, MPH, FIDSA, FSHEA6, (1)Infectious Diseases, Detroit Medical Center/Wayne State University, Detroit, MI, (2)Detroit Medical Center/Wayne State University, Detroit, MI, (3)Detroit Medical Center, Detroit, MI, (4)Infectious Diseases, Detroit Medical Center/ Wayne State University, Detroit, MI, (5)Detroit Cedical Center/Wayne State University, Detroit, MI, (6)Infectious Diseases, Detroit medical Center/ Wayne State University, Detroit, MI

    Disclosures:

    N. Tashtoush, None

    J. Pogue, CUBIST: Consultant and Speaker's Bureau , Consulting fee , Research grant and Speaker honorarium
    Actavis: Speaker's Bureau , Speaker honorarium
    theravance: Consultant and Speaker's Bureau , Consulting fee and Speaker honorarium

    B. Nishan, None

    D. Salem, None

    H. Shaikh, None

    M. Salim, None

    A. Pervaiz, None

    A. Kotecha, None

    S. Karino, None

    S. Dhar, None

    K. Kaye, CUBIST: Consultant and Speaker's Bureau , Consulting fee and Research grant
    Merck: Consultant , Consulting fee and Research grant

    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.