1797. The Impact of Infectious Diseases Consultations on Multi-Drug Resistant Gram-Negative Infections
Session: Oral Abstract Session: Resistance is Futile
Saturday, October 29, 2016: 11:35 AM
Room: 288-290
Background: Existing evidence suggests that when an infectious diseases (ID) specialist is involved in a patient’s care, patients are more often correctly diagnosed, have fewer complications, and experience improved outcomes. However, these data comes mostly from infections caused by gram-positive pathogens. To date, there are no studies published in the literature evaluating the role of ID consultations in the treatment of multidrug resistant (MDR) gram-negative (GN) infections. The purpose of this study was to evaluate the impact of ID consultation on GN MDR infections at a university hospital.

Methods: This was a single-center, retrospective, case-cohort study consisting of adult patients with bacteremias or urinary tract infections (UTIs) caused by MDR GN bacteria. Patients were stratified into three groups: those who received early consult (< 48 hours), late consult (>48 hours) or no consult. The primary endpoint was in-hospital mortality.

Results: A total of 205 patients were enrolled in this study. There were 65 patients that received ID consultation (40 early, 25 late); and 140 patients did not. There were 62 patients with bacteremias (30%) and 185 patients with UTIs (90%). In-hospital mortality occurred in 29% of the patients (60/205): 60% among those who received a late consult (15/25); 30% (45/140) among those who received no consults; and 0% in early consults (0/40). In bivariate analysis, early consult was associated with lower mortality than either late or none (p<0.001 for both comparisons); late consult was associated with higher mortality than none (p=0.026). The results were similar even after controlling for age, SAPSII score, Charlson comorbidity index, and antibiotic exposure in the past 90 days. Clinical cure was achieved in all surviving participants. Mean time to defervescence was estimated at 1.8 days (95% CI 1.3-2.3) for early consult, 5.3 days (95% CI 4.1-6.4) for late consult, and 4.9 days (95% CI 4.5-5.2) for no consult. The two most common organisms isolated were extended spectrum beta-lactamase producing Escherichia coli (51%) and Klebsiella pneumoniae (35%).

Conclusion: Consulting infectious diseases clinicians on MDR GN infections reduced in hospital mortality and decreased the time to defervescence.

Eris Cani, BS, PharmD, Pharmacy, SUNY Downstate Medical Center, Brooklyn, NY, Jessica Yager, MD, MPH, Infectious Diseases Medicine, SUNY Downstate Medical Center, Brooklyn, NY, Stanley Moy, PharmD, BCPS, SUNY Downstate Medical Center, Brooklyn, NY and Roopali Sharma, BS, PharmD, AAHIVP, BCPS (AQ-ID), Pharmacy, Touro College of Pharmacy/SUNY Downstate Medical Center, New York, NY

Disclosures:

E. Cani, None

J. Yager, None

S. Moy, None

R. Sharma, None

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