289. Vancomycin-Resistant Enterococcus (VRE) positive blood cultures: Results from a province-wide multi-site case series analysis in Ontario, Canada, January 2009-December 2013
Session: Poster Abstract Session: HAI: MSSA, MRSA, and other Gram-Positives
Thursday, October 27, 2016
Room: Poster Hall
Background: Since 2009, all Ontario hospitals are mandated to report VRE positive (+) blood cultures to a provincial public reporting database. The objective of this study was to better understand the clinical characteristics, microbiology and outcomes of patients with VRE+ blood cultures in Ontario, Canada.

Methods: A chart review of all cases reported by Ontario hospitals between January 2009 and December 2013 was performed by the Institute for Clinical and Evaluative Sciences using a standardized clinical data abstraction tool. False positives, incomplete or duplicate cases, as well as cases with a missing or invalid health card number were excluded from the analysis. Descriptive statistics were generated using SAS.

Results: In total, 311 VRE+ blood cultures were reported. After exclusions, the final study sample was n=232. Mean age was 61 years (range 1-97 years), 60% were male and 91% had at least one comorbidity, including: renal disease (34%), diabetes (28%), hematological malignancy (23%), non-hematological malignancy (11%) and transplant (solid organ [9%] and bone marrow [3%]); 42% were immunocompromised during their admission prior to their confirmed VRE+ blood culture and over half of patients (55%) were known to be VRE colonized. At the time of blood culture draw, 84% had a central line and 18% were neutropenic. Most VRE+ blood cultures (93%) were due to E. faecium. While 72% were given empiric antibiotics at the time of blood culture draw, only 17% of patients received effective empiric anti-VRE therapy (linezolid 14%, daptomycin 3%). Overall, 74% of patients with VRE+ blood cultures received effective anti-VRE therapy; not receiving effective anti-VRE therapy was associated with an increased risk of death within 7 days (OR 4.5, 95% CI 2.3-9.0). In total, 48% of patients died during their hospitalization. A review of death certificates found that 1% of deaths indicated VRE infection as the primary cause of death.

Conclusion: Most VRE+ blood cultures occurred in immunocompromised patients with invasive devices; nearly half of patients died during their hospital admission. Lack of effective anti-VRE therapy was associated with a significantly increased risk of death.

Jennie Johnstone, MD1, Cynthia Chen, MSc2, Michelle Policarpio, MSc2, Kwaku Adomako, MSc3, Laura Rosella, PhD2, Freda Lam, MPH, CPHI(C)3, Chatura Prematunge, MSc3, Emily Nadolny, MPH2, Jennifer Robertson, PhD3, Gary Garber, MD, FACP, FIDSA4 and the Ontario VRE Investigators, (1)University of Toronto, Toronto, ON, Canada, (2)Public Health Ontario, Toronto, ON, Canada, (3)Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada, (4)University of Ottawa, Ottawa, ON, Canada

Disclosures:

J. Johnstone, None

C. Chen, None

M. Policarpio, None

K. Adomako, None

L. Rosella, None

F. Lam, None

C. Prematunge, None

E. Nadolny, None

J. Robertson, None

G. Garber, None

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