347. Risk Factors for Mortality in Patients with Urinary and Sterile Site Cultures Positive for Carbapenem-resistant Enterobacteriaceae (CRE) in Atlanta, 2011-2014
Session: Poster Abstract Session: HAI: Multi Drug Resistant Gram Negatives
Thursday, October 27, 2016
Room: Poster Hall
  • Mortality Poster.pdf (464.5 kB)
  • Background:  Estimates of mortality in severe CRE infection have varied from ~30-50%.  We evaluated mortality in both urine and sterile-site (invasive) infection with CRE, and assessed associated risk factors.

    Methods:  The Georgia Emerging Infections Program performs active population-based laboratory surveillance for CRE in metropolitan Atlanta.  We conducted a retrospective chart review of CRE cases with isolation of a carbapenem-nonsusceptible E. coli, Klebsiella spp., or Enterobacter spp. from urine or a sterile site from 8/2011-12/2014.  In-hospital (if admitted) or 30-day mortality (for those in a long-term care or dialysis center) was compared for patients with only urine or sterile site culture positive, those with initial positive urine culture and subsequent invasive infection within 30 days (progression), and those with multiple positive cultures for the same organism >30 days apart (recurrence).  Univariate analyses and logistic regression were performed to identify risk factors associated with mortality. 

    Results:  The overall mortality rate was 11.7% (53/454), including 27 deaths in 371 patients with only urine cultures positive (7.3%) and 26 deaths in 83 patients with at least one invasive infection (31.3%) (see Figure 1).  Of deaths in patients with a history of invasive infection, 13 occurred in 60 patients at initial infection (22.9%), 3 occurred in 10 patients with progression (30.0%), and 9 occurred in 25 patients with a urinary or invasive recurrence (36.0%).  In univariable analysis, ICU stay (65.0% v 21.5%), a central line (67.5% v 23.7%), invasive infection (40.0% v 13.0%), hospitalization for >=3 days (45.0% v 17.9%), and a non-urinary indwelling device (67.5% v 30.4%) were more common in patients who died (p<0.0001).  In multivariable analysis, ICU stay (OR 3.80, 95% CI 1.75-8.24), a central line (OR 2.89, 95% CI 1.26-6.61), or invasive infection (OR 2.25, 95% CI 1.03-4.91) predicted mortality.

    Conclusion:  Unsurprisingly, patients with invasive infection and markers of severity of illness were more likely to die. Higher mortality occurred with progression and recurrent infection than initial invasive infection.  Early initiation of appropriate antibiotic therapy in these patients may prevent progression and decrease mortality.


    Mary Elizabeth Sexton, MD1,2, Chris Bower, MPH2,3,4 and Jesse T. Jacob, MD1,2, (1)Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, (2)Georgia Emerging Infections Program, Decatur, GA, (3)Atlanta Research and Education Foundation, Decatur, GA, (4)Atlanta Veterans Affairs Medical Center, Decatur, GA


    M. E. Sexton, None

    C. Bower, None

    J. T. Jacob, None

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