1252. Empiric Double Coverage for Healthcare-Associated Pneumonia (HCAP) – Is it Still Necessary?
Session: Poster Abstract Session: Clinical Infectious Diseases: Respiratory Infections
Friday, October 28, 2016
Room: Poster Hall
Background: Patients with healthcare-associated pneumonia (HCAP) are at risk for multidrug resistant gram-negative organisms, including Pseudomonas aeruginosa. Current empirical therapy recommendations include 2 agents with activity against Pseudomonas. However, the need for double coverage has been questioned. We characterized recent trends in resistance of gram-negative organisms in culture-positive HCAP using a large US inpatient database.

Methods: This retrospective cohort study assessed adult patients admitted with HCAP from 2010- 2015 to 170 US hospitals that participate in the Premier data base, providing administrative and microbacteriological data. HCAP was defined as ≥1 of the following: prior hospitalization within 90 days, hemodialysis, admission from skilled nursing facility, or immune suppression. Patients with identical gram negative organisms in blood and urine were excluded. Resistance to each class of antipseudomonal therapy was assed at the patient level.

Results: We identified 48,440 patients with HCAP, 17,452 (36.0%) patients were admitted to ICU. Mean age was 69±15 (range 18-89) and 23,896 (49.3%) were male, and 9,354 (19.7%) had a positive blood (21.5%) or respiratory (8.1%) culture. Of these, 50.5% were gram-negatives, most commonly P. aeruginosa, E. coli and K. pneumoniae; 50.8% were sensitive to all antipseudomonal drugs; 27.2% were resistant to 1 antipseudomonal class and 21.9% were resistant to 2 or more; 40.7% were resistant to quinolones, 21.0% to antipseudomonal cephalosporins, 21.0% to aminoglycosides, 22.3% to antipseudomonal penicillin (piperacillin/tazobactam) and 12.8% to carbapenems. Unadjusted mortality was similar for patients with organisms resistant to any antipseudomonal drug compared to those sensitive to all drugs (17.1% vs 17.6%, p=0.65). Resistance to any antipseudomonal drug fell from 55.6 in 2010 to 45.6 in 2015 (p for trend 0.004).

Conclusion: In a large contemporary US inpatient database, more than half of all gram negative HCAP pathogens were resistant to at least one class of antipseudomonal antibiotics, most often to quinolones. Resistance declined over five years, but our findings still support the recommendation for empiric double coverage of Pseudomonas in HCAP.

Abhishek Deshpande, MD, PhD1,2, Sarah Haessler, MD3, Kyle Brizendine, MD2, Peter Lindenauer, MD, MSc4, Tara Lagu, MD, MPH4, Pei-Chun Yu, MS5, Paul Bakaki, MD, PhD6, Penelope Pekow, PhD7 and Michael Rothberg, MD, MPH1, (1)Medicine Institute, Cleveland Clinic, Cleveland, OH, (2)Infectious Disease, Cleveland Clinic, Cleveland, OH, (3)Infectious Diseases, Baystate Medical Center, Springfield, MA, (4)Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, (5)Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, (6)Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, (7)Biostatistics and Epidemiology Department, School of Public Health and Health Sciences, University Of Massachusetts, Amherst, MA

Disclosures:

A. Deshpande, None

S. Haessler, None

K. Brizendine, None

P. Lindenauer, None

T. Lagu, None

P. C. Yu, None

P. Bakaki, None

P. Pekow, None

M. Rothberg, None

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.