2163. Risk Factors for Carbapenem-resistant Gram-Negative Bloodstream Infections (BSI) in US Hospitals (2010-2015)
Session: Poster Abstract Session: Healthcare Epidemiology: HAI Surveillance
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • 2163_IDWPOSTER2018_Premier_CR risk factors_CAI_V5.pdf (241.8 kB)
  • Background: Carbapenem-resistant (CR) Gram-negative (GN) infections are associated with higher mortality and extended hospital stays. Time to effective antibiotic treatment is important for patient survival. Classifying the risk factors for CR GN BSI before identification and susceptibility results are known is critical; this study explores the risk factors associated with CR GN BSI in US hospitals.

    Methods: BSI caused by 11 of the most common GN pathogens were identified from 181 acute care hospitals that contributed microbiology and susceptibility test data to the Premier Healthcare Database 2010-2015. We used univariate analyses to select potential risk factors and a multivariate logistic regression model to predict CR BSI with these risk factors.

    Results: Among 46,199 patients with GN BSI, 1,592 (3.6%) had CR pathogens. From univariate analyses, the significant factors (p-value <0.05) when comparing CR vs carbapenem susceptible (CS) infections were age, race, gender, geographic location, admission source, Charlson Comorbidity Index, having BSI while in the ICU or after having stayed in the ICU, and index culture day. Adjusted Odds Ratios (OR) from multiple logistic regression are shown below.
    Effect OR

    95%

    Confidence

    Limits

    Compared to 65-years-of-age (yoa)
    18-54 2.3 2.0 2.6
    55-64 1.6 1.4 1.9
    Male vs Female 1.2 1.05 1.3
    Black vs Non-black 1.2 1.04 1.3
    Index culture >48 hours post admission 2.9 2.5 3.3
    Transferred vs Other admission source 2.0 1.7 2.3
    Infection in/after ICU 1.5 1.3 1.8
    Compared to New England
    East South Central 1.9 1.4 2.7
    Middle Atlantic 1.5 1.1 1.9
    Mountain 3.1 2.2 4.2
    Pacific 1.0 0.8 1.3
    South Atlantic 0.8 0.6 1.05
    West North Central 0.7 0.5 1.02
    West South Central 0.8 0.6 1.05
    Myocardial infarction 0.6 0.4 0.8
    Congestive heart failure 1.2 1.1 1.4
    Peripheral vascular disease 1.3 1.14 1.6
    Cerebrovascular disease 0.6 0.4 0.8
    Dementia 1.3 1.1 1.4
    Renal disease 2.3 1.9 2.8
    Malignancy 1.5 1.3 1.7

    Conclusion: Patients with CR GN BSIs were more likely to be of a younger age group, transferred from a health care facility, stayed in ICU, and had positive BSI culture more than 48 hours after admission. Risk of CR BSI increased for patients with congestive heart failure, peripheral vascular disease, dementia, renal disease, and any malignancy.

    Bin Cai, MD, PhD1, Roger Echols, MD, FIDSA2, Deborah Rudin, MD1, Gareth Morgan, BA1 and Tsutae Nagata, MD, PhD, FFPM1, (1)Shionogi Inc., Florham Park, NJ, (2)ID3C, Easton, CT

    Disclosures:

    B. Cai, None

    R. Echols, None

    D. Rudin, None

    G. Morgan, None

    T. Nagata, 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.