1585. BLOODSTREAM INFECTION SURVEY in HIGH-RISK ONCOLOGY PATIENTS (BISHOP) with FEVER AND NEUTROPENIA (FN): Correlation between Initial Empiric Antibiotic Regimen Correlation and Susceptibility Patterns
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • ID week MICRO poster 36X20_Sept262018_Final.pdf (2.9 MB)
  • Background:

    The empiric initial antibiotic regimen (IAR) for treatment of febrile neutropenia (FN) relies on a knowledge of epidemiology and susceptibility patterns of bacterial bloodstream infections (BSI), especially in high risk patient populations, i.e. those receiving chemotherapy for hematologic malignancies (HM) or undergoing hematopoietic stem cell transplant (HCT). As the last U.S. national survey of BSI epidemiology in cancer patients was published in 2003, we sought to update these data focusing exclusively on high-risk patients with attention to IARs used and their concordance with susceptibilities of isolated bloodstream pathogens.

    Methods:

    A prospective ongoing survey among 14 high volume US cancer centers submitting clinical and microbiologic data from consecutive HM patients with BSI during first FN after cytotoxic chemotherapy or HCT. Concordance between antibiotic and BSI was determined by investigator (AZ, AF) interpretation of susceptibility reports provided by each center compared with IAR used, for single organism bacteremias only.

    Results:

    Among 294 FN bacteremic episodes (93 HCT), there were 336 bacterial pathogens (48.5% Gram negative [GN] 46.5% Gram positive [GP] and 6% anaerobes), with 88% monomicrobial episodes. E.coli and viridans group Streptococci (VGS) were the most commonly isolated GN and GP respectively, each accounting for nearly 25% of total organisms identified. IARs included cefepime 61%, piperacillin-tazobactam 24%, and meropenem 8%. Isolates were non-susceptible to the IAR in 38/227 (17%) of FN episodes. Antibiotic mismatch was more likely to occur with a non-VGS GP (37%) versus GN (13%) or VGS (2%) p<0.001.

    Conclusion:

    This is the first U.S. national survey of high-risk BSI in FN. Although mismatch between BSI and IAR occurs in 17% of FN bacteremia episodes, this is driven primarily by non-VGS GP isolates such as CoNS and MRSA. Currently used IARs, comprised primarily of cefepime and piperacillin-tazobactam, generally provide reliable coverage for GN isolates across the U.S. (87%) but careful tracking of this rate is essential to identify further erosion of coverage in the current era of antimicrobial resistance.

    Andrea Zimmer, MD, Internal Medicine: Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, Alison G. Freifeld, MD, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, Christopher Arnold, MD, Infectious Diseases and International Health, University of Virginia, Charlottesvill, VA, John W. Baddley, MD, University of Alabama at Birmingham, Birmingham, AL, Pranatharthi Chandrasekar, MD, Infectious Diseases, Wayne State University, Detroit, MI, Zeinab El Boghdadly, MBBCh, Department of Internal Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH, Carlos Gomez, MD, Department of Pathology, Stanford University School of Medicine, Stanford, CA, Eileen K. Maziarz, MD, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, Steven Pergam, MD, MPH, FIDSA, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, Kenneth V. Rolston, MD, Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, Gowri Satyanarayana, MD, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, Shmuel Shoham, MD, Washington Hospital Center, Washington, DC, Lynne Strasfeld, MD, Division of Infectious Disease, Oregon Health & Science University, Portland, OR, Randy Taplitz, MD, Division of Infectious Diseases, University of California San Diego Health Centers, San Diego, CA, Thomas J. Walsh, MD, PhD, Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine of Cornell University, New York, NY, Jo-Anne Young, MD, University of Minnesota, Minneapolis, MN, Jane Meza, PhD, UNMC, Omaha, NE, Yuning Zhang, Ph.D, University of Nebraska Medical Center, omaha, NE and BISHOP

    Disclosures:

    A. Zimmer, Merck: Investigator , Research grant .

    A. G. Freifeld, Merck: Investigator , Research grant .

    C. Arnold, None

    J. W. Baddley, None

    P. Chandrasekar, None

    Z. El Boghdadly, None

    C. Gomez, None

    E. K. Maziarz, None

    S. Pergam, Merck: Consultant , Consulting fee . Chimerix: Consultant , Consulting fee .

    K. V. Rolston, Merck: Investigator , Research grant . JMI Laboratories: Investigator , Research grant . Shionogi (Japan): Investigator , Research grant .

    G. Satyanarayana, None

    S. Shoham, Merck: Investigator and Scientific Advisor , Consulting fee and Grant recipient . Astellas: Investigator , Grant recipient . Shionogi (Japan): Investigator , Grant recipient . Gilead: Investigator , Grant recipient . Shire: Investigator , Grant recipient .

    L. Strasfeld, None

    R. Taplitz, None

    T. J. Walsh, Merck: Grant Investigator , Research grant . Atellas: Consultant , Grant Investigator and Scientific Advisor , Consulting fee and Research grant . Gilead: Scientific Advisor , Consulting fee . Allergan: Grant Investigator and Scientific Advisor , Consulting fee and Research grant . Scynexis: Grant Investigator , Research grant . Amplyx: Grant Investigator , Research grant . Shionogi: Scientific Advisor , Consulting fee .

    J. A. Young, GSK: Investigator , The University of Minnesota is reimbursed for contract costs associated with conducting clinical trials of vaccine. I receive no personal financial benefit. .

    J. Meza, Merck: Investigator , Research grant .

    Y. Zhang, Merck: Investigator , Research grant .

    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.