409. Multi-drug Resistant Organisms (MDROs) Have Escaped the Hospital: Evidence of Community Acquisition at a Regional Hospital
Session: Poster Abstract Session: HAI: MDRO-GNR/Emerging Resistant Bacterial Pathogens
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • ID Week Poster DASON format 2017.pdf (430.3 kB)
  • Background: MDROs pose a serious health threat. Community acquisition of MDROs is increasing, but its relative impact on the burden of MDROs in hospitals is unclear. We conducted a prospective study of patients with MDRO infections who received care at a regional hospital to examine the prevalence of community acquisition.

    Methods: This prospective cohort study enrolled adults with MDRO infections admitted between 2013 and 2016 at a 202-bed regional hospital. MDRO infections included MRSA, VRE, Gram negatives resistant to more than 3 antimicrobial classes and C difficile. Infections were defined as community-acquired if the patients met the following criteria: 1) the index culture was obtained either prior to or within the first 48 hours of admission and 2) the patient may not have been admitted for greater than 48 hours in the preceding 90 days. We separately examined the proportion of community acquired infections coming from nursing facilities.

    Results: 300 patients were enrolled. C difficile (45% of infections) and MRSA (35% of infections) were the most prevalent MDROs overall (table). 45 (42%) of MRSA infections, 46 (34%) of C difficilecolitis cases and 22 (50%) of MDR Gram negatives met criteria for community acquisition. Only 10 VRE infections were enrolled - none met criteria for community acquisition. Among community acquired infections, a minority came from nursing facilities (only 13 % of community acquired infections).

    Conclusion: C difficile and MRSA were the most common MDRO infections in our cohort of patients. More than 1/3 of MDROs were acquired in the community. These data suggest that all types of MDROs are no longer confined to healthcare settings and, in fact, are increasingly established in the community.

    Table:

     

    Infection Type1

    Acquisition:

    MDR Organism:

    BSI

    n (%)

    UTI

    n (%)

    LRI

    n (%)

    Other

    n (%)

    Community

    n (%)

    SNF2

    n (%)

    MRSA (n=106)

    40 (37)

    7 (7)

    46 (44)

    13 (12)

    45 (42)

    3 (7)

    C difficile (n=135)

    n/a

    n/a

    n/a

    135 (100)

    46 (34)

    8 (17)

    VRE

    (n=10)

    0

    6 (60)

    1 (10)

    3 (30)

    0

    0

    Gram negative (n=44)

    16 (36)

    25 (57)

    2 (4.5)

    1 (2)

    22 (50)

    4 (18)

    Total (n=295)

    56 (19)

    38 (13)

    49 (17)

    152 (52)

    112 (38)

    15 (13)

    1BSI – bloodstream infection; UTI – urinary tract infection; LRI – lower respiratory infection; source unknown for 5 patients

    2SNF – community-acquired in skilled nursing facility

    Nicholas Turner, MD1, Rebekah W. Moehring, MD, MPH1, Vance G. Fowler Jr., MD2, Kenneth Schmader, MD3,4, David J. Weber, MD, MPH5, Daniel J. Sexton, MD, FIDSA, FSHEA1 and Deverick J. Anderson, MD, MPH, FIDSA, FSHEA6, (1)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (2)Duke University Medical Center, Durham, NC, (3)Durham VAMC, Durham, NC, (4)Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, NC, (5)Medicine, Pediatrics, Epidemiology, University of North Carolina, School of Public Health, Chapel Hill, NC, (6)Duke Infection Control Outreach Network, Duke University Medical Center, Durham, NC

    Disclosures:

    N. Turner, None

    R. W. Moehring, None

    V. G. Fowler Jr., Pfizer, Novartis, Galderma, Novadigm, Durata, Debiopharm, Genentech, Achaogen, Affinium, Medicines Co., Cerexa, Tetraphase, Trius, MedImmune, Bayer, Theravance, Cubist, Basilea, Affinergy, Janssen, xBiotech, Contrafect: Consultant , Consulting fee
    NIH, MedImmune, Cerexa/Forest/Actavis/Allergan, Pfizer, Advanced Liquid Logics, Theravance, Novartis, Cubist/Merck; Medical Biosurfaces; Locus; Affinergy; Contrafect; Karius: Grant Investigator , Grant recipient
    Green Cross, Cubist, Cerexa, Durata, Theravance; Debiopharm: Consultant , Consulting fee
    UpToDate: Royalties , Royalties

    K. Schmader, Merck: Investigator , Research grant

    D. J. Weber, PDI: Consultant , Consulting fee

    D. J. Sexton, None

    D. J. Anderson, None

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