1193. Bacteremia in Cancer and Stem Cell Transplantation (SCT), risk factors for Multidrug-Resistant Bacteria (MDRB). Preliminary Data from the First Prospective, Multicenter Study in Argentina
Session: Poster Abstract Session: Transplant: Epidemiology of Infections in Transplant Patients and Other Patients with Impaired Immunity
Friday, October 9, 2015
Room: Poster Hall
Posters
  • Poster ID Week definitivo.pdf (348.6 kB)
  • Background: There is no data published from Argentina regarding MDRB infections in patients with cancer and SCT. The objectives are to describe clinical and microbiological characteristics of episodes of bacteremia in patients with cancer and SCT, comparing MDRB bacteremia with non-MDRB, and to evaluate risk factors associated with MDRB bacteremia.  

    Methods: Prospective multicenter study. Episodes of bacteremia in patients with cancer and SCT were included in 8 centers, from July 2014 to May 2015. Variables with p < .1 in univariate analysis or clinically relevant were entered in a logistic regression model for multivariate analysis of risk factors.

    Results: 254 episodes of bacteremia were included. 171 (67.6%) had hematological tumor, 39 (15.4%) had solid tumor and 43 (17%) had received SCT. Gram Negative Rods (GNR) were isolated in 167 episodes (66%), being Escherichia coli (31,1%), Klebsiella pneumoniae (26,3%) and Pseudomonas aeruginosa (15,5%) the most frequent. In 93 (37,5%) Gram Positive Cocci were identified, being Coagulase-negative staphylococci (CoNS) (32,6%) and Staphylococcus aureus (30,5%) the most common. In GNR bacteremia, 53,9% were resistant to quinolones, 48,5% to fourth generation cephalosporins, 44,9% to piperacilin/tazobactam, 23,3% to carbapenems, 15,6% to amikacin and 2,4% to colistin. 119 episodes (47%) had MDRB, being the most frequent extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (32,7%), multidrug-resistant CoNS (16%) and carbapenemase (KPC)-producing Enterobacteriaceae (10,1%). In multivariate analysis risk factors for MDRB bacteremia were previous antibiotic treatment (OR=2,45, IC95% 1.3-4,5, p=0.004), neutropenia (OR=2,46, IC95% 1.2-4,8, p=0.01) and central venous catheter (OR=2.09, IC95% 1.06-4,1, p=0.033). MDRB bacteremia episodes were associated with less adequate empirical treatment (57,1 vs 90,2%, p=0.001) and higher mortality at the seventh day (19,3 vs 9,8%, p=0.046) compared with non-MDRB.

    Conclusion: These data confirm that MDRB, especially GNR, are a great concern in our country, and pose a challenge regarding empirical treatment in this population. Coverage should include ESBL-producing Enterobacteriaceae particularly in those with the risk factors previously identified.

    Alberto Carena, MD1, Ana Laborde, MD2, Inés Roccia Rossi, MD3, Alejandra Valledor, MD4, Graciela Guerrini, MD5, Andrea Nenna, MD6, Rosana Jordán, MD7, Patricia Costantini, MD8, María Luz González Ibañez, MD2, Pilar Vizcarra, MD3, Victoria Pinoni, MD7, Martín Luck, MD8, Fabián Herrera, MD1 and Argentinean Bacteremia in Cancer and SCT Study Group, (1)Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, CEMIC, Buenos Aires, Argentina, (2)FUNDALEU, Buenos Aires, Argentina, (3)Hospital HIGA Gral. San Martín, La Plata, Argentina, (4)Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, (5)Hospital HIGA Dr. Rodolfo Rossi, La Plata, Argentina, (6)Hospital Municipal de Oncología Marie Curie, Buenos Aires, Argentina, (7)Hospital Británico de Buenos Aires, Buenos Aires, Argentina, (8)Instituto de Oncología Angel H. Roffo, Buenos Aires, Argentina

    Disclosures:

    A. Carena, None

    A. Laborde, None

    I. Roccia Rossi, None

    A. Valledor, None

    G. Guerrini, None

    A. Nenna, None

    R. Jordán, None

    P. Costantini, None

    M. L. González Ibañez, None

    P. Vizcarra, None

    V. Pinoni, None

    M. Luck, None

    F. Herrera, 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.