2061. Epidemiology and Management of Skin and Soft Tissue Infection (SSTI) due to Carbapenem Resistant Enterobacteriaceae: A Report from The Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRaCKle)
Session: Poster Abstract Session: Antimicrobial Resistant Infections: Treatment
Saturday, October 29, 2016
Room: Poster Hall

Background:

SSTI due to carbapenem-resistant enterobacteriaceae (CRE) are management challenges due to limitations in effective antimicrobial options.

The objectives of this study were to describe the epidemiology and clinical course of SSTIs and/or wound colonization due to CRE and to identify variables associated with surgical debridement. 

Methods:

CRaCKle is a prospective multicenter consortium.  Data pertaining to patients with wound cultures positive for CRE were prospectively collected from 12/24/11-10/1/14. Wound cultures were classified as SSTI or colonization using standard criteria. Predictors of surgical debridement were analyzed.

Results:

Of the 142 patients with CRE isolated from a wound culture, 62 had SSTI (44%) and 82 (56%) were colonized. The mean age was 61 years, 48% were male and 56% were white.  48% of the patients were admitted from skilled nursing facilities (SNFs), and 31% from home (Table).  The median Charlson score was 3.0 (range 0-9). 53% of patients had diabetes and 13% were immunocompromised.  Most of the patients (67%) were cared for in intensive care units or on surgical wards.  68 patients (48%) had surgical intervention, half of whom underwent debridement in the operating room.

In bivariate analysis for the entire cohort (table), PITT score >3 and SSTI were associated with debridement (OR 2.35, 95% CI 1.14-4.85; OR 4.97, 95% CI 2.43-10.20, respectively). In multivariable analysis, SSTI was associated with surgical debridement.  Among patients with SSTI (n=62), those admitted from a SNF were less likely to undergo surgical debridement (OR 0.16, 95% CI 0.04-0.66).

Conclusion:

Patients with CRE SSTI who were admitted from SNFs were significantly less likely to undergo wound debridement.

Table: Predictors of surgical intervention

Surgical debridement

N=68 (%)

No Surgical debridement

N=74 (%)

OR (95% CI)

Adjusted OR (95% CI)

Pitt score > 3

28 (41.2%)

17 (23%)

2.35 (1.14- 4.85)

2.15 (0.95-4.87)

Origin

    Home

26 (38%)

19 (25.7%)

1.79 (0.87- 3.66)

    SNF

25 (36.8%)

44 (59%)

0.39 (0.20- 0.78)

0.4 (0.19-0.86)

    Long term acute

    care

4 (5.9%)

6 (8.1%)

0.7 (0.19-2.6)

    Hospital transfer

19 (19.1%)

5 (6.8%)

3.26 (1.09- 9.7)

SSTI

43 (63.2%)

19 (25.7%)

4.97 (2.43-10.20)

4,26 (2.0-9.08)

Extremity wound

24 (35.3%)

15 (20.3%)

2.14 (1.01-4.56)

1.9 (0.81-4.53)

                       

Oryan Henig, MD1, David Van Duin, MD, PhD2, Eric Cober, MD3, Sandra S. Richter, MD4, Federico Perez, MD5,6, Robert Salata, MD7, Robert Kalayjian, MD8, Richard Watkins, MD, MS9,10, Yohei Doi, MD, PhD11, Scott Evans, PhD, MS12, Vance G Fowler Jr, MD, MHS13,14, Robert A. Bonomo, MD7,15,16,17 and Keith Kaye, MD18, (1)Infectious Disease, Wayne State University, Detroit Medical Center, Detroit, MI, (2)Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, (3)Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, (4)Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, (5)Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, (6)Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, (7)Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleavland, OH, (8)Department of Medicine, MetroHealth Medical Center, Cleveland, OH, (9)Division of Infectious Diseases, Akron General Medical Center, Akron, OH, (10)Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, OH, (11)Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, (12)Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA, (13)Duke Clinical Research Institute, Duke University, Durham, NC, (14)Infectious Diseases, Duke University Medical Center, Durham, NC, (15)Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH, (16)Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleavland, OH, (17)Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleavland, OH, (18)Detroit Medical Center and Wayne State University, Detroit, MI

Disclosures:

O. Henig, None

D. Van Duin, None

E. Cober, None

S. S. Richter, bioMerieux: Research funding , Research support
Nanosphere: Research funding , Research support
BD Diagnostics: Research Funding , Research support
Roche: Research funding , Research support
Biofire: Research funding , Research support
OpGen: Research funding , Research support

F. Perez, None

R. Salata, None

R. Kalayjian, None

R. Watkins, None

Y. Doi, None

S. Evans, None

V. G. Fowler Jr, None

R. A. Bonomo, None

K. Kaye, None

<< Previous Abstract | Next Abstract

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.