2401. Risk factors for Antimicrobial Resistance in Invasive Pneumococcal disease (IPD) in Toronto, Canada, 2012-2017
Session: Poster Abstract Session: Treatment of AMR Infections
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • thomas fear IPD AMR poster5.pdf (775.0 kB)
  • Background: Several studies have documented factors predictive of antimicrobial resistance (AMR) in invasive pneumococcal disease(IPD). However, the implementation of routine pediatric PCV programs, antimicrobial stewardship, and increasing immunocompromised in populating might be expected to change such factors. We report on predictive factors for AMR in IPD from 2012-2017.

    Methods: TIBDN performs population-based surveillance for IPD in Toronto/Peel (pop 4.5M). IPD cases are reported to a central office and one isolate/case is serotyped and has antimicrobial susceptibility testing performed by broth microdilution to CLSI standards.

    Results: 2459 cases of IPD were identified from 1/2012 to 12/2017. Overall rates of resistance to penicillin, macrolides, fluoroquinolones, and TMP-SMX were relatively stable over the course were stable over the study. Risk factors for infection with resistant to penicillin at meningitis breakpoints as opposed to penicillin- susceptible pneumococci were current residence at nursing home (odds ratio [OR], 2.30; P < .001), immune compromised status (OR, 1.41; P = 0.012), HIV infection (OR 2.13, P = 0.016), history of receiving PPV23 vaccine (OR 1.38; P = 0.007). Infection with TMP-SMX–resistant pneumococci was associated with HIV infection (OR, 3.2; P=0.001) and current residence in a nursing home (OR 2.4, P = 0.002). Infection with macrolide-resistant isolates was associated with any use of macrolide 3 months prior to infection (OR, 3.24; P < 0.001), or macrolide treatment failure of the current episode (OR, 6.64; P = 0.003). Infection with levofloxacin-resistant pneumococci was associated with current residence in a nursing home (OR, 13.7; P < .001), and fluorquinolone treatment failure of the current episode (OR 49.4, P = 0.0034).

    Conclusion: Previous same class antibiotic exposure remains a major predictive factor for macrolide resistance. History of treatment failure is a predictive factor for macrolide and fluoroquinolone failure. HIV infection and immune compromise are risk factors for IPD infection with penicillin resistant pneumococci. Hospital acquisition of infection is no longer a risk factor for fluoroquinolone resistance.

    Thomas Fear, MD1, Karen Green, MSc, RN2, Agron Plevneshi, BSc2, Jeff Li, BSc2, Wallis Rudnick, MSc2, Sarah Nayani, PhD3, Allison McGeer, MD, MSc4 and Toronto Invasive Bacterial Diseases Network, (1)Internal Medicine, University of Toronto, Toronto, ON, Canada, (2)Mount Sinai Hospital, Toronto, ON, Canada, (3)Microbiology, Sinai Health System, Toronto, ON, Canada, (4)Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

    Disclosures:

    T. Fear, None

    K. Green, None

    A. Plevneshi, None

    J. Li, None

    W. Rudnick, None

    S. Nayani, None

    A. McGeer, 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.