1793. Relationship between Cumulative Number of Prior Antibiotic Exposures and Carbapenem Resistance among Patients with Hospital-Onset Infections due to Enterobacteriaceae spp
Session: Poster Abstract Session: Resistant Gram-Negative Infections: CRE Epidemiology
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • CRE Risk factor poster_ID Week_FINAL.pdf (293.2 kB)
  • Background: It is well documented that receipt of prior antibiotics is a risk factor for developing antibiotic-resistant infections. Despite the increasing incidence of infections due to carbapenem resistant Enterobacteriaceae (CRE), the association between cumulative number of prior antibiotics and hospital-onset CRE infections has not been well characterized.

    Methods: Retrospective analysis of Premier hospital database with ≥ 1 infection due to CRE. Study period: 1/2011-9/2014. Inclusion criteria: (1) age ≥ 18 yrs; (2) ICD-9 discharge diagnosis for a complicated urinary tract infection, complicated intra-abdominal infection, hospital-associated pneumonia, or bloodstream infection; (3) index culture positive for Enterobacteriaceae spp. from a site consistent with infection ≥ 3 day after admission; (4) receipt of antibiotic on day of index culture or the two-day period thereafter.  CRE was defined as Enterobacteriaceae that are non-susceptible to meropenem, imipenem, doripenem, or ertapenem. Prior antibiotic exposure was defined as use of antibiotic with activity against Gram-negative bacteria prior to index culture submission in the qualified admission. The relationship between prior antibiotic exposure, listed as the cumulative number of prior antibiotics from 0 to ≥ 5, and the probability of CRE was assessed and stratified by residence in the ICU.

    Results: During the study period, 10,634 patients across 115 hospitals ≥ 1 infection due to CRE met the inclusion criteria.  Overall CRE prevalence was 4.5%. The relationship between prior antibiotic exposure and CRE, stratified by residence in the ICU, is shown in table. 

     

    Cumulative number of Prior AB

    Residence in ICU

    Residence in non-ICU

     

    CRE (n/N)

    Total Proportion

    CRE

    Total Proportion

    0

    3/199

    1.5

    9/380

    2.4

    1

    22/848

    2.6

    31/1868

    1.7

    2

    41/1275

    3.2

    44/1731

    2.5

    3

    56/1127

    5.0

    44/955

    4.6

    4

    61/734

    8.3

    38/506

    7.5

    ≥ 5

    87/677

    12.9

    45/334

    13.5

    Conclusion: In this analysis of over 10,000 hospitalized patients with invasive infections due to CRE across 115 hospitals, the proportion of hospital onset CRE rose with increased numbers of prior antibiotics.  Among patients with ≥ 5 prior antibiotics, the risk of CRE exceeded 12% in both the ICU and non-ICU.

    Thomas Lodise, PharmD, PhD1, Michael Ye, MS2 and Qi Zhao, MD, MPH2, (1)Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY, (2)Actavis, Inc, Jersey City, NJ

    Disclosures:

    T. Lodise, Actavis, Inc: Consultant , Consulting fee

    M. Ye, Actavis, Inc: Employee , Salary

    Q. Zhao, Actavis, Inc: Employee , Salary

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