1573. Antipseudomonal Drug Exposure Associated with MDR Organisms in the Liver and Lung Transplant Population
Session: Poster Abstract Session: Stewardship: Improving Outcomes
Friday, October 6, 2017
Room: Poster Hall CD
Posters
  • MulugetaS_IDWeek2017.pdf (250.1 kB)
  • Background: Multi-drug resistant (MDR) Gram-negative bacteria (GNB) are an emerging complication in transplant recipients. This study describes the prevalence of and risk factors for MDR-GNB infection/colonization in the liver and lung transplant population.

    Methods: Cross-sectional study with nested case-case-control included adult liver or lung transplant candidates/recipients from 1/10-7/16. Patients with a positive GNB culture were classified as MDR- or Susceptible (S)-cases; MDR was defined as in vitro resistance to ≥ 3 antibiotic classes. Patients without a positive GNB culture were controls. Primary variable of interest: antibiotic days of therapy (DOT) during time at risk. Patient and isolate characteristics were collected and compared.

    Results: We included 150 patients: 110 (73%) liver, 40 (27%) lung. Median (IQR) patient age and Charlson comorbidity index were 59 years (52-63) and 5 points (3-6). Isolated organisms: 31 (34%) E. coli, 28 (31%) K. pneumoniae, 33 (36%) others. Resistance to cefepime, piperacillin/tazobactam, and ertapenem: 38%, 27%, and 14%. 61 (41%) MDR-GNB, 21 (14%) S-GNB, 68 (45%) controls. Median (IQR) cumulative antibiotic DOT was: MDR-case – 24.5 days (6-46.5), S-case – 5 days (2-24, p=0.017 vs MDR), controls – 0 days (0-10, p<0.001 vs MDR). Median (IQR) antipseudomonal (AP) DOT was: MDR-case – 7 days (1-16), S-case – 1 day (0-8, p=0.055 vs MDR), controls – 0 days (0-1, p<0.001 vs MDR); AP exposure was independently associated with MDR-GNB infection/colonization after correcting for severity of disease pre-transplant (adjOR: 2.9, 95% CI: 1.6-5.3) (Table 1).

    Conclusion: MDR-GNB represent a significant burden to the liver and lung transplant population. A detailed antibiotic history, including AP DOT, may help with risk assessment to guide empiric therapy selection.

    Table 1. Variables associated with MDR-GNB infection/colonization during time at risk (AdjOR, 95% CI)

    MDR-cases vs S-cases,

     (n=82)

    MDR-cases vs controls,

     (n=129)

    MDR-cases vs combined comparator, (n=150)

    High MELD (> 30) or LAS (>50)

    1.1 (0.6-1.9)

    1.3 (0.7-2.3)

    1.5 (0.8-2.6)

    AP drug exposure

    1.1 (0.6-2.0)

    3.5 (1.9-6.3)

    2.9 (1.6-5.3)

    Prior hospitalization

    0.9 (0.7-1.0)

    Surafel G Mulugeta, PharmD, MS1, Michael P Veve, PharmD1,2, Arin S Jantz, PharmD1, Odaliz Abreu Lanfranco, MD1 and Susan L Davis, PharmD1,3, (1)Henry Ford Hospital, Detroit, MI, (2)Wayne State University College of Pharmacy, Detroit, MI, (3)Pharmacy Practice, Wayne State University, Detroit, MI

    Disclosures:

    S. G. Mulugeta, None

    M. P. Veve, None

    A. S. Jantz, None

    O. Abreu Lanfranco, None

    S. L. Davis, Allergan: Grant Investigator and Scientific Advisor , Consulting fee and Research grant
    Merck: Grant Investigator and Scientific Advisor , Consulting fee and Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.