2439. Outcomes of Minocycline Use on Gram-Negative Infections and Implications of MIC
Session: Poster Abstract Session: Treatment of AMR Infections
Saturday, October 6, 2018
Room: S Poster Hall
Background: Minocycline (MINO) is a treatment option for Acinetobacter baumannii and Stenotrophomonas maltophilia infections due to high in vitro susceptibility. Literature suggests it may also be an option for carbapenamase-producing enterobacteriaceae. MINO minimum inhibitory concentrations (MICs) vary by organism and dosing varies by center. Additional data are needed to assess MINO effectiveness in gram-negative infections and determine if a relationship exists between MIC and treatment outcomes.

Methods: Retrospective study evaluating MINO use in adults at NewYork-Presbyterian Hospital from 2012-2017. Patients included received MINO ≥ 2 days for a culture-positive gram-negative infection (CDC/NHSN criteria) susceptible to MINO. Patients with MINO started > 5 days after positive culture or with untreated polymicrobial infections were excluded. The primary outcome was clinical failure at the end of therapy. Secondary outcomes included 30-day mortality, development of resistance or recurrence within 90 days.

Results: 114 pts were included: majority were male (51%) with median age 57 yrs. Median duration was 12 days with 8 pts receiving high-dose MINO (≥ 150 mg q12H). S. maltophilia was the most prevalent pathogen (72%) followed by Klebsiella pneumoniae (16%) with a median MINO MIC of 1 mg/L. 68% of pts received combination therapy. Treatment success was observed in 71 pts (63%). Pts with treatment failure had higher median Charlson Comorbidity Index (5 vs. 3; p=0.026), SOFA score (7 vs. 5; p=0.028), and were more likely to have underlying leukemia or lymphoma (39% vs. 7%; p<0.001). No differences were seen in primary or secondary outcomes between combination and monotherapy regimens. MICs had no impact on failure outcome, 30-day mortality or 90-day recurrence (all p>0.05); however, MICs ≤ 2 mg/L were associated with increased development of resistance (34% vs. 12%; p=0.021). In a multivariable analysis, vasopressor use (OR 2.79; 95%CI 1.05,7.41; p = 0.04) and underlying leukemia/lymphoma (OR 4.49; 95%CI 1.26,15.95; p = 0.02) were associated with increased risk of treatment failure.

Conclusion: MINO MIC impacted resistance, but did not correlate with treatment failure, mortality or recurrence. Severity of illness and comorbidities but not choice of MINO may be associated with clinical failures.

Jennifer Cheng, PharmD, NewYork-Presbyterian Hospital, New York, NY and Christine J. Kubin, PharmD BCPS (AQ-ID), Columbia University Medical Center, New York, NY

Disclosures:

J. Cheng, None

C. J. Kubin, 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.