823. Clinical features and risk factors for development of breakthrough Gram-negative bacteremia during carbapenem therapy
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 9, 2015
Room: Poster Hall
Posters
  • 2015 ID week poster wide(JY Lee).pdf (350.1 kB)
  • Background:  Carbapenem-resistant gram-negative bacteria have become a major concern in healthcare-associated infectionsThis study was performed to evaluate clinical and microbiologic features of breakthrough gram-negative bacteremia (GNB) during carbapenem therapy and to assess risk factors for development of breakthrough GNB. 

    Methods: A retrospective case-control study was performed including adult patients at a 1,950-bed tertiary-care hospital, from September 2005 tJuly 2014Cases were defined as individuals whose blood cultures grew gram-negative bacteria, who had been receiving imipenem, meropenem or doripenem for at least 48 hours before breakthrough bacteremia. Each case was matched to a control patient who had no breakthrough bacteremia during carbapenem therapy.

    Results : A total of 101 cases with breakthrough GNB were included and compared with 100 controlsThe causative pathogens for breakthrough GNB were Stenotrophomonas maltophilia (n=33, 32.7%)Acinetobacter baumannii (n=3231.7%), Pseudomonas aeruginosa (n=2120.8%), and others (n=15, 14.9%)Among 32 A.baumannii and 21 P. aeruginosa isolates27 (84.4%) and 17 (81.0%) were non-susceptible to carbapenems received, respectively. Among S. maltophilia isolates causing bacteremia during carbapenem therapy, 90% were susceptible to levofloxacin and trimethoprim/sulfamethoxazoleIunivariate analysis, the longer hospital stay (more than 28 days before administration of carbapenems), leukemia, lymphomaallogenic hematopoietic stem cell transplantation, persistent neutropenia during carbapenem therapyimmunosuppressant use and previous colonization at respiratory tract were significantly associated with development of breakthrough GNB (all P < 0.05)In multivariate analysis using a logistic regression modelthe longer hospital stay before administration of carbapenems (OR, 32.4; 95% CI, 4.52-232.67) and having lymphoma (OR, 139.2; 95% CI, 2.78-6969.68) were found to be independent risk factors.

    Conclusion : Our study suggests that the most likely pathogens are S. maltophiliaA. baumannii, or P.aeruginosa when breakthrough GNB occurs during carbapenem therapy, especially in patient with hematologic malignancy. The independent risk factors found in this study were the longer hospital stay before administration of carbapenems and having lymphoma.

    Ji-Yong Lee, internal medicine/MD1, Cheol-in Kang, MD2, Jae-Hoon Ko, MD3, Ji-Yeon Lee, MD4, Hye-Ri Seok, MD5, Ga-Eun Park, MD5, Sun Young Cho, MD6, Young Eun Ha, MD2, Doo Ryun Chung, MD PhD5, Kyong Ran Peck, MD5, Jae-Hoon Song, PhD, MD2 and Woo Joo Lee, MD5, (1)Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Seoul, South Korea, (2)Division of Infectious Diseases, Samsung Medical Center, Seoul, South Korea, (3)Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, (4)Samsung Medical center, Seoul, South Korea, (5)Samsung Medical Center, Seoul, South Korea, (6)Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Disclosures:

    J. Y. Lee, None

    C. I. Kang, None

    J. H. Ko, None

    J. Y. Lee, None

    H. R. Seok, None

    G. E. Park, None

    S. Y. Cho, None

    Y. E. Ha, None

    D. R. Chung, None

    K. R. Peck, None

    J. H. Song, None

    W. J. Lee, None

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