1253. Impact of inappropriate empiric treatment of Enterobacteriaceae UTI, pneumonia and sepsis on hospital outcomes
Session: Poster Abstract Session: Clinical Infectious Diseases: Respiratory Infections
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Medicine_poster_IET (2).pdf (98.8 kB)
  • Background:

    Inappropriate empiric therapy (IET) for severe bacterial infections increases the risk for death. The growing prevalence of antibiotic resistance reduces the chance of receiving appropriate treatment. In view of the rising incidence of infections due to carbapenem resistant Enterobacteriaceae (CRE), we sought to explore the relationship between IET and outcomes in a large US database of patients hospitalized with community-onset Enterobacteriaceae urinary tract infection (UTI), pneumonia, and sepsis.

    Methods:

    We conducted a retrospective cohort study in the Premier Research database (2009-2013) of 175 US hospitals. We included all adult patients admitted with UTI, pneumonia, or sepsis as principal diagnosis, or as a secondary diagnosis in the setting of respiratory failure, along with antibiotic administration within 2 days of admission. Only culture confirmed infections were included. Patients with hospital-onset infection or transfers from other acute care facilities were excluded. IET was defined as not receiving an antibiotic within 2 days of obtaining a positive culture that covered the corresponding organism. We used propensity score matching to compute the adjusted effect of IET on hospital mortality, length of stay (LOS) and patient costs.

    Results:

    Among 36,304 patients, 5,162 (14.2%) received IET for infections due the Enterobacteriaceae. Those receiving IET were older (70.0+15.1 vs. 68.9+16.0, p<0.001), more likely to be African American (17.6% vs. 13.5% , p<0.001), and had a higher chronic (Charlson comorbidity score 2.0+2.0 vs. 1.8+2.1, p<0.001) and acute illness burdens (by day 2: ICU 44.5% vs. 40.9%, p<0.001 and mechanical ventilation 22.2% vs. 15.1%, p<0.001). CRE was isolated far more frequently in patients treated inappropriately (11.1%) than non-IET patients (1.7%, p<0.001). 97.8% of IET patients were propensity matched. IET exposure was associated with higher adjusted hospital mortality (relative risk ratio 1.16; 95% CI 1.05,1.29 p=0.005), LOS (excess 4.7 days; 95% CI 4.1, 5.2, p<0.001) and costs (excess $11,011; 95% CI $9,494, $12,528, p<0.001) compared to non-IET.

    Conclusion:

    In this large US cohort of patients with Enterobacteriaceae infections, infection due to CRE was highly associated with receiving IET. IET increased the risk of in-hospital mortality and contributed substantially to excess LOS and costs.

    Marya D. Zilberberg, MD, MPH, University of Massachusetts and Evimed Research Group, LLC, Goshen, MA, Brian Nathanson, PhD, OptiStatim, LLC, Longmeadow, MA, Kate Sulham, MPH, The Medicines Company, Parsippany, NJ, Weihong Fan, MS, The Medicines Company, Parssipany, NJ and Andrew F. Shorr, MD, MPH, Pulmonary and Critical Care Medicine, Washington Hospital Center, Washington, DC

    Disclosures:

    M. D. Zilberberg, The Medicines Company: Grant Investigator and Investigator , Grant recipient , Research grant and Research support
    Tetraphase: Grant Investigator and Investigator , Grant recipient , Research grant and Research support
    Merck, Inc.: Consultant , Grant Investigator and Investigator , Grant recipient , Research grant and Research support

    B. Nathanson, The Medicines Company: Investigator , Research support

    K. Sulham, The Medicines Company: Employee and Shareholder , Salary

    W. Fan, The Medicines Company: Employee and Shareholder , Salary

    A. F. Shorr, The Medicines Company: Consultant , Grant Investigator and Investigator , Grant recipient , Research grant and Research support
    Tetraphase: Consultant , Grant Investigator , Investigator and Scientific Advisor , Consulting fee , Grant recipient , Research grant and Research support
    Merck, Inc.: Consultant , Grant Investigator , Investigator and Speaker's Bureau , Grant recipient , Research grant and Speaker honorarium

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.