1384. The Utility of Routine Admission Surveillance Cultures in Long-Term Acute Care Hospital Patients
Session: Poster Abstract Session: HAI: Long Term Care
Friday, October 28, 2016
Room: Poster Hall
Posters
  • ID week poster final.pdf (594.0 kB)
  • Background: Long-term acute care hospital (LTACH) patients are at high risk for colonization and infection with multidrug-resistant organisms (MDROs). However, there are limited data on the use of surveillance cultures for infection prevention in this setting. The objective of this study was to evaluate the utility of admission surveillance cultures in LTACH patients, including rates of positivity, and the rate of inappropriate treatment for asymptomatic bacteriuria (ASB).

    Methods: All patients admitted to a university LTACH from 2008 through 2014 were included. During this period, all patients had routine blood and urine cultures performed on admission. Monthly rates of positive blood and urine cultures were calculated, including for MDROs. Medical record review using National Healthcare Safety Network surveillance definitions were used to identify and determine treatment of ASB.

    Results: Of 2,001 total admissions, there were 151 positive admission blood cultures (rate of 7.24 positive per 100 admissions) and 631 positive admission urine cultures (rate of 30.3 positive per 100 admissions) (Figures 1 and 2). The most common organisms identified on blood cultures are shown in Figure 3. Rates of resistance were high, with 55% extended-spectrum beta-lactamase-positive Enterobacteriaceae, 91% methicillin-resistant Staphylococcus aureus (MRSA), 71% extended-spectrum cephalosporin-resistant Pseudomonas aeruginosa, and 50% vancomycin-resistant Enterococcus (VRE). Of the 369 urine cultures with ≤2 bacterial organisms, 44 (12%) were urinary tract infections, and 325 (88%) were ASB. Sixty (19%) of patients with ASB received antibiotic treatment.

    Conclusion: Rates of positive blood and urine cultures on admission were high in LTACH patients, particularly with MDROs. Notably, while rates of coagulase-negative staphylococci were high, clinically significant organisms were also frequently identified on surveillance blood cultures in patients recently discharged from acute care hospitals. In addition, the rate of inappropriate antibiotic treatment for ASB was high. Future studies should focus on interventions for timely identification of infections in this critically ill population and strategies to reduce unnecessary antibiotic use.

    Figure 1 

    Figure 2

     

     

    Figure 3

     

    Lauren Dutcher, MD, Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA, Naasha Talati, MD, University of Pennsylvania Health System, Philadelphia, PA, Jacqueleen Wise, BA, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA and Jennifer Han, MD, MSCE, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

    Disclosures:

    L. Dutcher, None

    N. Talati, None

    J. Wise, None

    J. Han, None

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