1043. Evaluation of Early Clinical Failure Criteria for Gram-Negative Bloodstream Infections
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 5, 2018
Room: S Poster Hall
  • Rac_ID Week 2018_Early Clinical Failure.pdf (298.8 kB)
  • Background: Early identification of patients at high risk of morbidity and mortality following Gram-negative bloodstream infections (GN-BSI) based on initial clinical course may prompt adjustments to optimize diagnostic and treatment plans. This retrospective cohort study aims to develop early clinical failure criteria (ECFC) to predict unfavorable outcomes in patients with GN-BSI.

    Methods: Adults with community-onset GN-BSI who survived hospitalization for at least 96 hours at Palmetto Health hospitals in Columbia, SC, USA from January 1, 2010 to June 30, 2015 were identified. Multivariate logistic regression was used to examine association between clinical variables within 72-96 hours of BSI and unfavorable outcomes (28-day mortality or hospital length of stay >14 days).

    Results: Among 766 patients with GN-BSI, 225 (29%) had unfavorable outcomes. After adjustments for Charlson Comorbidity Index and appropriateness of empirical antimicrobial therapy in multivariate model, predictors of unfavorable outcomes included systolic blood pressure <100 mmHg or vasopressor use (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.1-2.5), heart rate >100/min (aOR 1.7, 95% CI 1.1-2.5), respiratory rate ≥22/min or mechanical ventilation (aOR 2.1, 95% CI 1.4-3.3), altered mental status (aOR 4.5, 95% CI 2.8-7.1), and peripheral WBC count >12x103/mm3 (aOR 2.7, 95% CI 1.8-4.1) at 72-96 hours from index BSI. Area under receiver operating characteristic curve of ECFC model in predicting unfavorable outcomes was 0.77 (0.84 and 0.71 in predicting 28-day mortality and prolonged hospitalization separately, respectively). Predicted 28-day mortality increased from 1% in patients with no ECFC to 3%, 7%, 16%, 32%, and 54% in presence of each additional criterion (p<0.001). Predicted hospital length of stay was 7.5 days in patients without any ECFC and increased by 4.0 days (95% CI 3.1-4.9, p<0.001) in presence of each additional criterion.

    Conclusion: Risk of 28-day mortality or prolonged hospitalization can be estimated within 72-96 hours of GN-BSI using ECFC. These criteria may have utility in future clinical research in assessing response to antimicrobial therapy based on a standard evidence-based definition of early clinical failure.

    Hana Rac, PharmD1, Alyssa Gould, PharmD2, P. Brandon Bookstaver, PharmD, FCCP, FIDSA, BCPS, AAHIVP1,3, Julie Ann Justo, PharmD, MS1,3, Joseph Kohn, PharmD, BCPS3 and Majdi N. Al-Hasan, MBBS4,5, (1)Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, (2)Novant Health Presbyterian Medical Center, Novant Health, Charlotte, NC, (3)Palmetto Health Richland, Columbia, SC, (4)Department of Medicine, Palmetto Health/ Univserity of South Carolina Medical Group, Columbia, SC, (5)University of South Carolina School of Medicine, Columbia, SC


    H. Rac, None

    A. Gould, None

    P. B. Bookstaver, CutisPharma: Scientific Advisor , <$1000 . Melinta Therapeutics: Speaker's Bureau , <$1000 .

    J. A. Justo, None

    J. Kohn, None

    M. N. Al-Hasan, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.