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162. Association Between Antibiotic Use and Multidrug-Resistant Organism Detection in Advanced Cancer Patients on Palliative Chemotherapy

BACKGROUND: Data suggest end-of-life antibiotics predispose to multidrug-resistant organism (MDRO) acquisition in intensive care units (ICUs). Less is known regarding antibiotics and MDRO acquisition in other palliative care populations. METHODS: We conducted a nested case–control study of advanced...

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Autores principales: Datta, Rupak, McManus, Dayna, Topal, Jeffrey, Quagliarello, Vincent, Juthani-Mehta, Manisha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252583/
http://dx.doi.org/10.1093/ofid/ofy209.032
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author Datta, Rupak
McManus, Dayna
Topal, Jeffrey
Quagliarello, Vincent
Juthani-Mehta, Manisha
author_facet Datta, Rupak
McManus, Dayna
Topal, Jeffrey
Quagliarello, Vincent
Juthani-Mehta, Manisha
author_sort Datta, Rupak
collection PubMed
description BACKGROUND: Data suggest end-of-life antibiotics predispose to multidrug-resistant organism (MDRO) acquisition in intensive care units (ICUs). Less is known regarding antibiotics and MDRO acquisition in other palliative care populations. METHODS: We conducted a nested case–control study of advanced cancer patients aged ≥65 years started on palliative chemotherapy from January 2016 to September 2017 at Yale New Haven Hospital. We identified patients with (cases) and without (controls) new MDRO detected from clinical or surveillance cultures from the first hospitalization after starting palliative chemotherapy. All patients had no history of MDRO, and 3 controls were randomly selected per case. Antibiotic use was defined as exposure on or prior to the MDRO culture collection date in cases or during the entire hospitalization in controls. The association between antibiotics and MDRO detection was assessed with χ(2) and multivariable logistic regression testing. Length of stay (LOS) was compared between groups. RESULTS: Of 1,181 advanced cancer patients started on palliative chemotherapy and subsequently admitted, we identified 45 cases and 135 controls (figure). Overall, median age was 75 years (range 65–95) and 48% (N = 87/180) were female. Antibiotic exposure was more likely in cases (91%, N = 41/45) vs. controls (75%, N = 101/135; P = 0.02). In regression testing adjusted for gender, LOS, and ICU stay, antibiotic use was associated with MDRO detection (OR = 3.23, 95% CI 1.1, 9.8; P = 0.04). Mean LOS was higher in those with (8.7 days, 95% CI 7.5, 10.0) vs. without (3.5 days, 95% CI 3.8, 6.1) MDRO detection (P = 0.002) CONCLUSION: In older advanced cancer patients on palliative chemotherapy, antibiotic use is predictive of new MDRO detection, and patients with new MDRO detection have significantly longer LOS. These results suggest antibiotics should be used cautiously in palliative care patients in whom the burdens of MDRO detection, such as longer LOS and potential room isolation with contact precautions, may conflict with goals of care. [Image: see text] DISCLOSURES: M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor, Consulting fee.
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spelling pubmed-62525832018-11-28 162. Association Between Antibiotic Use and Multidrug-Resistant Organism Detection in Advanced Cancer Patients on Palliative Chemotherapy Datta, Rupak McManus, Dayna Topal, Jeffrey Quagliarello, Vincent Juthani-Mehta, Manisha Open Forum Infect Dis Abstracts BACKGROUND: Data suggest end-of-life antibiotics predispose to multidrug-resistant organism (MDRO) acquisition in intensive care units (ICUs). Less is known regarding antibiotics and MDRO acquisition in other palliative care populations. METHODS: We conducted a nested case–control study of advanced cancer patients aged ≥65 years started on palliative chemotherapy from January 2016 to September 2017 at Yale New Haven Hospital. We identified patients with (cases) and without (controls) new MDRO detected from clinical or surveillance cultures from the first hospitalization after starting palliative chemotherapy. All patients had no history of MDRO, and 3 controls were randomly selected per case. Antibiotic use was defined as exposure on or prior to the MDRO culture collection date in cases or during the entire hospitalization in controls. The association between antibiotics and MDRO detection was assessed with χ(2) and multivariable logistic regression testing. Length of stay (LOS) was compared between groups. RESULTS: Of 1,181 advanced cancer patients started on palliative chemotherapy and subsequently admitted, we identified 45 cases and 135 controls (figure). Overall, median age was 75 years (range 65–95) and 48% (N = 87/180) were female. Antibiotic exposure was more likely in cases (91%, N = 41/45) vs. controls (75%, N = 101/135; P = 0.02). In regression testing adjusted for gender, LOS, and ICU stay, antibiotic use was associated with MDRO detection (OR = 3.23, 95% CI 1.1, 9.8; P = 0.04). Mean LOS was higher in those with (8.7 days, 95% CI 7.5, 10.0) vs. without (3.5 days, 95% CI 3.8, 6.1) MDRO detection (P = 0.002) CONCLUSION: In older advanced cancer patients on palliative chemotherapy, antibiotic use is predictive of new MDRO detection, and patients with new MDRO detection have significantly longer LOS. These results suggest antibiotics should be used cautiously in palliative care patients in whom the burdens of MDRO detection, such as longer LOS and potential room isolation with contact precautions, may conflict with goals of care. [Image: see text] DISCLOSURES: M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor, Consulting fee. Oxford University Press 2018-11-26 /pmc/articles/PMC6252583/ http://dx.doi.org/10.1093/ofid/ofy209.032 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Datta, Rupak
McManus, Dayna
Topal, Jeffrey
Quagliarello, Vincent
Juthani-Mehta, Manisha
162. Association Between Antibiotic Use and Multidrug-Resistant Organism Detection in Advanced Cancer Patients on Palliative Chemotherapy
title 162. Association Between Antibiotic Use and Multidrug-Resistant Organism Detection in Advanced Cancer Patients on Palliative Chemotherapy
title_full 162. Association Between Antibiotic Use and Multidrug-Resistant Organism Detection in Advanced Cancer Patients on Palliative Chemotherapy
title_fullStr 162. Association Between Antibiotic Use and Multidrug-Resistant Organism Detection in Advanced Cancer Patients on Palliative Chemotherapy
title_full_unstemmed 162. Association Between Antibiotic Use and Multidrug-Resistant Organism Detection in Advanced Cancer Patients on Palliative Chemotherapy
title_short 162. Association Between Antibiotic Use and Multidrug-Resistant Organism Detection in Advanced Cancer Patients on Palliative Chemotherapy
title_sort 162. association between antibiotic use and multidrug-resistant organism detection in advanced cancer patients on palliative chemotherapy
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252583/
http://dx.doi.org/10.1093/ofid/ofy209.032
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