1545. Gram-negative Bacteremia in Neutropenic Patients: Risk Factors for Mortality in the Era of Multiresistance
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • IDWeek. Poster 1545.pdf (1.7 MB)
  • Background:

    Gram-negative bacteremia (GNB) in neutropenic patients is a major cause of infection-related mortality

    Our objective was to identify factors associated with 7-day and 30-day mortality during GNB episodes in neutropenic patients.

    Methods:

    Prospective multicenter study. Episodes of GNB in adult neutropenic cancer and Hematopoietic Stem Cell Transplant (HSCT) patients were included in 10 centers of Argentina, from May 2014 to January 2018. To identify factors associated with 7-day and 30-day mortality, variables with p < 0.05 in univariate analysis were included in a logistic regression model for multivariate analysis.

    Results:

    Four hundred and seventy six episodes of GNB were included. From these, 68.06% had hematological malignancies, 22.90% HSCT and 9,03% solid tumors. 7-day and 30-day mortality were 19.53% and 26.47%, respectively. In multivariate analysis, factors independently associated with 7-day mortality were: Meropenem-resistant GNB (OR, 8.60, 95% CI, 3.06-24.14, p = <0.0001), respiratory source (OR, 3.67, 95% CI, 1.21-11.10, p = 0.021), skin and soft tissue source (OR, 3.89, 95% CI, 1.01-14.94, p= 0.048), Charlson score > 4 (OR, 2.76, 95% CI, 1.06-7.19, p=0.037) and shock (OR, 7.13, 95% CI, 2.50-20.33, p = <0.0001). Independent factors for 30-day mortality were: Meropenem-resistant GNB (OR, 7.06, 95% CI, 2.83- 17.64, p = <0.0001), respiratory source (OR, 4.41, 95% CI, 1.53-12.73, p = 0.006), skin and soft tissue source (OR, 3.66, 95% CI, 1.00-13.42, p= 0.049), Charlson score > 4 (OR, 3.81, 95% CI, 1.62-8.91, p=0.002), intensive care unit requirement (OR 2.46, 95% CI, 1.00-6.04, p=0.049), shock (OR, 10.90, 95% CI, 4.12-29.85, p = <0.0001) and refractory cancer (OR, 4.30, 95% CI, 1.57-11.78, p = 0.005).

    Conclusion:

    The identification of certain prognostic factors would allow the stratification of neutropenic patients at high risk for mortality during GNB episodes. The appropriate medical intervention of a multidisciplinary team on these factors could improve the outcome of these patients. Since Meropenem-resistant GNB is one of strongest prognostic factors, it is essential to identify the patients at risk and treat them appropriately.

    Fabián Herrera, MD1, Ana Laborde, MD2, Rosana Jordán, MD3, Inés Roccia Rossi, MD4, Graciela Guerrini, MD5, Alejandra Valledor, Infectious Diseases Specialist6, Patricia Costantini, MD7, Miguel Dictar, MD8, Andrea Nenna, MD9, Juan Pablo Caeiro, MD10, Diego Torres, MD1, María Luz Gonzalez Ibañez, MD2, Victoria Pinoni, MD3, Facundo Argüello, MD11, Martín Luck, MD7, Agustina Racioppi, MD8, Fernando Poletta, PhD12, Alberto Carena, MD1 and Argentinean Bacteremia in Cancer and HSCT Study Group, (1)Infectious Diseases, Centro de Educación Médica e Investigaciones Clí­nicas, CEMIC, Buenos Aires, Argentina, (2)FUNDALEU, Buenos Aires, Argentina, (3)Hospital Británico de Buenos Aires, Buenos Aires, Argentina, (4)Hospital HIGA Gral. San Martín, La Plata, Argentina, (5)Hospital HIGA Dr. Rodolfo Rossi, La Plata, Argentina, (6)Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, (7)Instituto de Oncología Angel H. Roffo, Buenos Aires, Argentina, (8)Instituto Alexander Fleming, Buenos Aires, Argentina, (9)Hospital Municipal de Oncología Marie Curie, Buenos Aires, Argentina, (10)Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina, (11)Hospital HIGA Gral. San Martín, La PLata, Argentina, (12)Research Unit, Centro de Educación Médica e Investigaciones Clínicas, CEMIC, Buenos Aires, Argentina

    Disclosures:

    F. Herrera, None

    A. Laborde, None

    R. Jordán, None

    I. Roccia Rossi, None

    G. Guerrini, None

    A. Valledor, None

    P. Costantini, None

    M. Dictar, None

    A. Nenna, None

    J. P. Caeiro, None

    D. Torres, None

    M. L. Gonzalez Ibañez, None

    V. Pinoni, None

    F. Argüello, None

    M. Luck, None

    A. Racioppi, None

    F. Poletta, None

    A. Carena, None

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