2375. A 17-Year Nationwide Study of Burkholderia cepacia Complex (Bcc) Blood Stream Infections (BSI) Among Patients in the Veterans Health Administration (VHA)
Session: Oral Abstract Session: Epidemiology and Outcomes of Resistant Gram-Negative Organisms
Saturday, October 29, 2016: 2:30 PM
Room: 388-390

Background: Bcc are a multidrug resistant group of at least 20 closely related species and a recognized cause of respiratory disease in patients with cystic fibrosis (CF) and immunocompromised adults, but BSIs are uncommon. We investigated the clinical characteristics, resistance patterns and treatment outcomes of Bcc BSI among VHA patients.

Methods: All cases of BSI with Bcc at the VHA facilities nationwide between 1999 and 2015 were reviewed. Factors associated with 90-day mortality were identified in a multivariate logistic regression (MVLR) analysis.

Results: 248 unique cases were found in a 17-year period (Table 1). Overall, < 20% of cases were treated with TMP/SMX, 28% of tested isolates were not susceptible to ceftazidime, and previous antibiotic use was significantly associated with both ceftazidime resistance and 90-day mortality. In a MVLR model predicting 90-day mortality, the Charlson Comorbidity Index (CCI) and combination antibiotic therapy were associated with significantly higher mortality [OR=1.2, 95% CI (1.1-1.3); OR=2.9, 95% CI (1.4-6.0)]. Healthcare acquisition, relative to hospital-acquired infection, and ID consultation appeared protective [OR=0.2, 95% CI (0.1-0.7), (OR=0.4, 95% CI (0.2-0.8)].

Conclusion: In the VHA, Bcc BSIs occurred in elderly, chronically ill patients in whom we observed high rates of mortality (36% at 90 days). This is the largest study of Bcc BSIs to date and describes the clinical and microbiological behavior of Bcc in non-CF patients. It also identifies knowledge gaps in the treatment of Bcc with a majority of patients not receiving the drug of choice (TMP/SMX); and reveals unexpectedly high level resistance to the second-line agent ceftazidime.

Table 1

Survived (n=159)

Died (n=89)

p-value

Age - mean (sd)

65.16 (12.50)

72.10 (10.74)

<0.001

Male

155 (97.5)

87 (97.8)

1

CCI - mean (sd)

6.41 (2.63)

7.54 (2.63)

0.001

PBS - mean (sd)

1.27 (1.59)

4.17 (3.52)

<0.001

Source

0.043

   CVC

70 (44.0)

31 (34.8)

   Pneumonia

27 (17.0)

22 (24.7)

   Other

26 (15.6)

7 (7.8)

   Unknown

36 (22.6)

29 (32.6)

Acquisition

<0.001

   CAI

19 (11.9)

4 (4.5)

   HCAI

82 (51.6)

73 (82.0)

   HAI

58 (36.5)

12 (13.5)

Prior antibiotic

118 (74.2)

82 (92.1)

0.001

ID consultation

96 (60.4)

42 (47.2)

0.061

Combination therapy

38 (23.9)

36 (40.4)

0.01

Data in no. (%) unless specified

PBS Pitt Bacteremia Score; CVC Central Venous Catheter; CAI Community Acquired Infection; HAI Hospital Acquired; HCAI Healthcare Associated

 

 

Nadim G. El Chakhtoura, MD1, Elie Saade, MD, MPH1, Brigid Wilson, PhD2, Federico Perez, MD1,3,4, Krisztina Papp-Wallace, PhD5 and Robert A. Bonomo, MD6,7, (1)Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, (2)Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, (3)Medicine Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, (4)Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, (5)Case Dept of Pharmacology and Cleveland VAMC, Cleveland, OH, (6)Medicine, Pharmacology and Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH, (7)Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH

Disclosures:

N. G. El Chakhtoura, None

E. Saade, None

B. Wilson, None

F. Perez, Pfizer: Grant Investigator , Grant recipient
Actavis: Consultant , Consulting fee

K. Papp-Wallace, None

R. A. Bonomo, Merck: Grant Investigator and Scientific Advisor , Consulting fee and Research grant
Allergan: Grant Investigator , Research grant
Wockhardt: Grant Investigator , Research grant
GlaxoSmithKline: Grant Investigator , Research grant
AstraZeneca: Grant Investigator , Research grant
Actavis: Invited Speaker , Speaker honorarium

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