1890. A Prospective Study of Enterococcal Bacteremia in Cancer vs. Non-Cancer Populations: One Disease, Two Tales
Session: Poster Abstract Session: Clinical: Bacteremia and Endocarditis
Saturday, October 7, 2017
Room: Poster Hall CD
Background: Enterococcal bacteremia (EB) affects mainly critically ill, immunocompromised patients and those with catheters or foreign bodies. In particular, patients with hematological malignancies seem to be at high risk of developing EB. The epidemiology of EB affecting cancer vs non-cancer populations is not clearly studied

Methods: We performed a prospective, observational cohort study of adult patients with EB in 2 tertiary hospitals (a general hospital [GH] and a major cancer center [CC]) located in Houston, TX, between September 2016 and March 2017. We included individuals with EB for whom follow-up blood culture data within 7 days of the index culture were available. Microbiologic failure (MF) was defined as clearance of bacteremia ≥ 4 days after the 1st blood culture. Data were assessed by the Chi-squared and Wilcoxon rank-sum test

Results: A total of 116 individual cases of EB were included (47 vs 69 in the GH and CC, respectively); E. faecalis and E. faecium were the most common species in both institutions, with E. faecalis more frequently isolated in the GH than in the CC (87 vs 42%; p<0.0001). In contrast, VRE (all E. faecium) were more common in the CC than in the GH (16% vs 6%, respectively). Presence of a line when EB occurred was more frequent in the CC (23 vs 13%, respectively). Infectious diseases consultation was requested in ca. 75% of cases in both hospitals. Endocarditis occurred in 19% of the cases in the GH but was rare in the CC (1%). Directed therapy with a single agent was the main treatment strategy in the GH compared to the CC (59% vs 27%; p=0.001). Ampicillin (AMP) and vancomycin were commonly used as monotherapy in the GH whereas daptomycin (DAP) and vancomycin were drugs of choice in the CC. Combination therapy was used in 36% and 51% in the GH and CC, respectively with AMP + gentamicin and DAP + tigecycline used in GH vs the CC, respectively. MF did not differ between centers, occurring in in 36% and 25% of the cases in the GH and CC, respectively (p = NS). All cause mortality at 30 days was 11% vs 30% in the GH vs CC, respectively (p=0.009)

Conclusion: Major differences in the epidemiology and management of EB between nearby hospitals were found. Our data indicate that specific stewardship initiatives need to be tailored according to the type of clinical setting when dealing with EB

Jose M. Munita, MD, Center for Antimicrobial Resistance and Microbial Genomics (CARMiG), University of Texas McGovern Medical School, Houston, TX; Instituto De Ciencias e Innovacion En Medicina (ICIM), Clinica Alemana Universidad del Desarrollo, Santiago, Chile, German Contreras, MD MSc, Pediatric Infectious Diseases, University of Texas McGovern Medical School, Houston, TX, Pranoti Sahasrabhojane, MS, The University of Texas MD Anderson Cancer Center, Houston, TX, Gabriela Sanchez Petitto, MD, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, Rafael Araos, MD, MMSc, Clinica Alemana de Santiago, Universidad del Desarrollo School of Medicine, Genomics and Resistant Microbes (GeRM) Group, Chile, Santiago, Chile, Audrey Wanger, PhD, Department of Pathology and Lab Medicine, Department of Pathology and Laboratory Medicine, McGovern Medical School, Houston, TX, Samuel L. Aitken, PharmD, Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, Samuel A. Shelburne, MD, PhD, Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX and Cesar Arias, MD, PhD, FIDSA, Microbiology and Molecular Genetics, University of Texas McGovern Medical School, Houston, TX; Molecular Genetics and Antimicrobial Resistance Unit - International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia

Disclosures:

J. M. Munita, None

G. Contreras, None

P. Sahasrabhojane, None

G. Sanchez Petitto, None

R. Araos, None

A. Wanger, None

S. L. Aitken, None

S. A. Shelburne, None

C. Arias, None

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