339. Carbapenem-resistance in Enterobacteriaceae among hospitalized patients with urinary tract infection, pneumonia and sepsis increases the risk of receiving inappropriate empiric treatment
Session: Poster Abstract Session: HAI: Multi Drug Resistant Gram Negatives
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Medicine_poster_CRE .pdf (110.4 kB)
  • Background:

    Drug resistance among gram-negative pathogens is a risk factor for receiving inappropriate empiric treatment (IET), which in turn increases mortality risk 2-4-fold. We explored the impact of carbapenem-resistant Enterobacteriaceae (CRE) on the risk of IET in patients with community-onset infections.

    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 a urinary tract infection (UTI), pneumonia or sepsis as principal diagnosis, or as a secondary diagnosis in the setting of respiratory failure. Patients with hospital acquired infections or transfers from other acute facilities were excluded Appropriate therapy was considered receipt of antibiotic therapy active against the cultured-confirmed pathogen within 2 days of admission. Only culture confirmed infections were included. Patients with hospital acquired infections or transfers from other acute facilities were excluded. IET was defined as receipt of inactive antibiotics within 2 days of obtaining positive culture of the cultured organism. We employed regression modeling to compute the independent impact of CRE on the risk of receiving IET.

    Results:

    Among 40,137 patients presenting to the hospital with Enterobacteriaceae UTI, pneumonia or sepsis, 1,227 (3.1%) were CRE. The majority of the cases were UTI (51.4% CRE and 54.3% non-CRE). Those with CRE were younger (66.6+/-15.3 vs. 69.1+/-15.9 years, p<0.001), and more likely to be African-American (19.7% vs. 14.0%, p<0.001) than those with non-CRE. Both chronic (Charlson score 2.0+/-2.0 vs. 1.9+/-2.1, p=0.009) and acute illness burdens were higher among CRE than non-CRE, respectively (by day 2: ICU 56.3% vs. 30.4%, p<0.001, and mechanical ventilation 35.8% vs. 11.7%, p<0.001). CRE patients were 4x more likely to receive IET than non-CRE (46.5% vs. 11.8%, p<0.001). In a multivariable regression model, CRE was a strong predictor of receiving IET (adjusted relative risk ratio 3.1, 95% confidence interval 2.7 to 3.6, p<0.001).

    Conclusion:

    In this large US database, the prevalence of CRE among patients with Enterobacteriaceae UTI, pneumonia or sepsis was comparable to other national estimates. Harboring CRE was associated with a >3-fold increased adjusted risk of receiving IET.

    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.