1543. The More Resistant, the More Fatal: Results of 414 Bacteremia Episodes in Febril Neutropenic Patients
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • IDWEEK 2018 POSTER 12.09.18.pdf (625.9 kB)
  • Background: The objective of this study is to investigate the features of antimicrobial resistance in the microorganisms isolated from  blood cultures of cases with FN and the relationship between resistance and mortality rates.

    Methods: We conducted a single centre retrospective surveillance study of hospitalized cases with FN who had bloodstream infection (BSI) between 2012 and 2016. Organisms were identified according to current conventional procedures.

    Results:  We determined 414 episodes of BSI in 252 patients of whom 53.6% were male and median age was 50 years. Distribution of common microorganisms causing BSI are presented in Figure 1.  Rates and patterns of  resistant microorganisms are presented in Table 1 and Figure 2. Catheter-related bacteremia constituted 49.8% (206 /414) of total episodes and 30-day mortality was significantly lower (p<0.007) in this group. In total, 30-day crude mortality rate was 14.7% (61 /414 episodes). The mortality rates were 7.4%, 18.6%, 32.4% and 50% in BSI episodes due to Gram-positive, Gram-negative bacterial,  polymicrobial and fungal etiology respectively. Among Gram negatives 30-day mortality was significantly associated with presence of resistance; Extended-spectrum beta-lactamase (ESBL) (p=0.006), carbapenem resistance (p<0.0001), piperacillin/tazobactam resistance (p<0.0001) and colistin resistance (p=0.009). Among Gram positives 30-day mortality was not associated with presence of resistance.

    Conclusion: The rate of carbapenem and colistin resistance has increased over the years. Changing antimicrobial resistance pattern particularly in Gram negatives is among the most decisive parameters for the success of empirical treatment and antimicrobial stewardship.

     

    Table 1: Resistance profiles of common isolates

    Microorganisms

    ESBL(+)

     

    Carbapenem resistance

     

    Colistin resistance

     

    Multi-drug resistance (MDR)

    Methicillin resistance

     

    Vancomycin resistance

     

    Echerichia coli(n=82)

    31

    7

    0

    28

    -

    -

    Klebsiella spp.(n=64)

    42

    24

    6

    41

    -

    -

    Pseudomonas spp. (n=31)

    -

    13

    0

    13

    -

    -

    Acinetobacter baumannii (n=17)

    -

    14

    2

    12

    -

    -

    Coagulase negative staphylococci (n=172)

    -

    -

    -

    -

    141

    0

    Staphylococcus aureus (n=6)

    -

    -

    -

    -

    1

    0

    Enterococcus spp (n=20)

    -

    -

    -

    -

    -

    8

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    Figure 1. Distribution of pathogens

    Figure 2.  Rate of resistant microorganisms

     

     
     

    Serkan Surme, MD1, Yusuf E. Ozdemir, MD1, Meryem Sahin, MD1, Ilker I. Balkan, Assoc Prof1, Bilgul Mete, MD1, Gunay Can, Prof2, Fehmi Tabak, Prof1 and Nese Saltoglu, Prof Dr, MD1, (1)Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey, (2)Health Science, CERRAHPASA MED─░CAL FACULTY, ─░stanbul, Turkey

    Disclosures:

    S. Surme, None

    Y. E. Ozdemir, None

    M. Sahin, None

    I. I. Balkan, None

    B. Mete, None

    G. Can, None

    F. Tabak, None

    N. Saltoglu, 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.