Methods: We performed a retrospective cohort analysis of consecutive adult patients (age ≥18 years) with a positive blood culture for GN pathogens (11 most prevalent pathogens reported in approximately 53,811 study patient samples), hospitalized in 1 of 181 institutions contributing microbiology data to the Premier Healthcare Database (Oct 2010–Sep 2015). We compared patients with CR vs carbapenem-susceptible (CS) BSIs based on their characteristics and outcomes. Primary outcome was mortality, and secondary outcomes included post-index culture hospital and ICU lengths of stay (LOS), and likelihood of being discharged home.
Results: Of the approximately 53,811 study patient samples, 46,381 patients had a GN BSI, with the prevalence of CR occurring at 3.5% (n=1,602). Compared to patients with CS, those with CR were younger (mean/SD 60.4/17.1 vs 67.4/16.4 years, p<0.01), more likely to be male (52.8% vs 45.9%, p<0.01), black (22.7% vs 17.7%, p<0.01), and had Medicaid as a payor (18.1% vs 10.9%, p<0.01). The mean/SD Charlson Comorbidity Index was higher in CR than CS group (2.9/2.5 vs 2.3/2.5, p<0.01). Crude mortality was also higher (20.6% vs 9.7%, p<0.01) in the setting of CR than CS, as were unadjusted median (IQR) post-index culture hospital (9 [6, 15] vs 7 [5, 10] days, p<0.01), and ICU (5 [2, 11] vs 3 [2, 6] days, p<0.01) LOS. Patients with CR BSI were less likely to be discharged home than those with CS (32.7% vs 53.8%, p<0.001).
Conclusion: Patients with CR BSIs have lower likelihood of surviving hospitalization or being discharged home, and longer post-index culture hospital and ICU LOS, compared to those with CS BSIs. This highlights the need for better and more preventive and therapeutic strategies aimed at combating GN CR.
B. Cai, None
T. P. Lodise Jr., Motif BioSciences: Board Member , Consulting fee .