258. High Rates of Multidrug Resistance in Diabetic Foot Infection in Detroit Area: Does It Matter?
Session: Poster Abstract Session: Clinical: Skin and Soft Tissue
Thursday, October 5, 2017
Room: Poster Hall CD
Background: Multidrug resistant organisms (MDROs) are important diabetic foot infection (DFI) pathogens. This study evaluated the impact of DFI due to MDROs (MDRO-DFI) on clinical outcomes.

Methods: Adults admitted to Detroit Medical Center from 1/2012-12/2015 with culture-positive DFI were included. Associations between outcomes and MDRO-DFI (evaluated as a single group that included methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci, Enterobacteriaceae resistant to 3rd generation cephalosporins and/or carbapenems (Enterobacteriacae-R), Acinetobacter baumannii, and Pseudomonas aeruginosa) were analyzed. Outcomes included above and below knee lower extremity amputation (LEA) and readmissions and mortality within a year following DFI. A propensity score predicting the likelihood of having MDRO-DFI was computed by comparing patients with MDRO-DFI to patients with DFI not due to MDROs (non-MDRO-DFI). A conditional logistic model was constructed for each outcome, and MDRO-DFI was analyzed as an independent variable after patients in the MDRO and non-MDRO groups were matched by propensity score.

Results: 674 patients were included, with a mean age of 58.6±13.8. 64% were male and 73% African American. Median Charlson score was 7 (IQR 5-9). Most patients (n=394, 59%) had MDRO-DFI and MRSA was the most common (235, 60% of MDRO-DFI patients), followed by P. aeruginosa(25%) and Enterobacteriaceae-R (15%). In bivariate analyses LEA and one-year readmission were more common in the MDRO-DFI group (Table). However, in propensity-adjusted analyses, MDRO-DFI was no longer associated with LEA or hospital readmission.

Conclusion: LEA occurred in > 20% of DFI-MDRO patients, and more than 60% of patients were readmitted to the hospital within a year following a DFI-MDRO episode. In propensity-adjusted analyses, DFI-MDRO was not significantly associated with these clinical outcomes. Table: Impact of DFI-MDRO on outcomes

MDRO-DFI

N=394

N (%)

Non-MDRO-DFI

N=280

N (%)

OR

(95% CI)

Adjusted OR

(95% CI)

LEA

79 (20.5)

38 (13.6)

1.60 (1.05-2.43)

1.44 (0.82-2.54)

One-year mortality

22 (6.7)

14 (6.2)

1.09 (0.52-2.17)

0.77 (0.32-1.86)

One-year readmission

253 (64.2)

150 (53.6)

1.56 (1.14-2.13)

1.14 (0.79-1.65)

LEA, lower extremity amputation

Oryan Henig, MD1, Jason M. Pogue, PharmD2,3, Raymond Cha, PharmD4, Sorabh Dhar, MD5,6, Umar Hayat, MD7, Mahmoud Ja'Ara, Student7, Paul E Kilgore, MPH, MD8 and Keith S. Kaye, MD, MPH9, (1)Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, MI, (2)Department of Pharmacy Services, Sinai-Grace Hospital; Detroit Medical Center, Detroit, MI, (3)Wayne State University School of Medicine, Detroit, MI, (4)Pharmacy, Eugene Appelbaum College of Pharmacy, Wayne State University, Detroit, MI, (5)John D. Dingell VA Medical Center, Detroit, MI, (6)Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, MI, (7)Detroit Medical Center, Detroit, MI, (8)Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, (9)Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, MI

Disclosures:

O. Henig, None

J. M. Pogue, None

R. Cha, None

S. Dhar, None

U. Hayat, None

M. Ja'Ara, None

P. E. Kilgore, None

K. S. Kaye, None

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