2428. Lower rates of antibiotic treatment of vancomycin resistant compared to vancomycin susceptible enterococcal bacteriuria
Session: Poster Abstract Session: Treatment of AMR Infections
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • Kale-Pradhan VRE VSE ID Week 2018 9-27-18 FINAL.pdf (212.9 kB)
  • Background: According to the IDSA guidelines, most asymptomatic bacteriuria should not be treated. The identification of drug resistance often leads to inappropriate antibiotic prescribing. We evaluated prescribing patterns of vancomycin-resistant enterococci (VRE) and vancomycin-susceptible enterococci (VSE) at a regional health system to determine if the rates differ by institution.

    Methods: This is a retrospective chart review of all adult inpatients at the St. John Providence Health System (SJPHS) with positive urine culture identified as VRE or VSE between 4/1/17-10/1/17. The groups were matched to hospital location, age within 5 years and gender. Patients with medical records that were not available were excluded. Patient demographics (age, sex), location of patient (institution), ID consult, fever, treatment, antibiotic class and the duration of treatment was collected. Bacteriuria was defined as a UTI if there was fever or enterococcal bacteremia. We evaluated frequency of treatment as well as type and duration of antibiotics.

    Results: 208 patients with VRE bacteriuria at SJPHS were identified and 106 met our inclusion criteria. 1,304 of VSE bacteriuria at SJPHS were identified and 106 were matched. The mean age was 70.4 and 71.3 (p= 0.476) in the VRE and VSE groups respectively and each group had 35.8% males. The table below depicts the number of patients with VRE/VSE being treated by institution.

    Site

    Included

    ID Consult

    Number Treated

    Fever

    (+) BCx

    Median length of Rx (days)

    Hospital 1

    22/22

    20/14

    5/4

    8/4

    2/2

    7/14.5

    Hospital 2

    47/47

    40/27

    15/21

    8/5

    0/0

    7/7

    Hospital 3

    5/5

    4/3

    1/2

    2/0

    0/0

    7/13

    Hospital 4

    22/22

    16/13

    5/12

    3/3

    0/1

    7/7

    Hospital 5

    10/10

    9/5

    4/6

    2/3

    0/0

    6.5/8.5

    Total

    106/106

    89/62 (p<0.0001)

    30/45 (p=0.0085)

    23/15

    (p=0.21)

    2/3

    7/7

    Therapy for VRE was diverse among most institutions and included agents such as daptomycin, beta-lactams, doxycycline, fosfomycin, nitrofurantoin and linezolid. Hospital 2 had a total of 15 treated cases; 11 of which were treated with linezolid. Therapy for VSE primarily consisted of beta-lactam or vancomycin.

    Conclusion: The rates of treatment were higher with VSE compared to VRE. ID was more frequently consulted in patients with VRE and those patients were treated less frequently.

    Bridget Vendittelli, Pharm.D., Pharmacy, St. John Hospital and Medical Center, Detroit, MI, Pramodini Kale-Pradhan, PharmD, Wayne State University, Detroit, MI and Leonard Johnson, MD, Infectious Diseases, Saint John Hospital and Medical Center; Ascension, Grosse Pointe Woods, MI

    Disclosures:

    B. Vendittelli, None

    P. Kale-Pradhan, None

    L. Johnson, 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.