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1171. Impact on Mortality, Length of Stay, and Antibiotic Use in Allogenic and Autologous Stem Cell Transplant Patients Colonized With Carbapenemase-Producing Enterobacteriaceae
BACKGROUND: Carbapenemase producing Enterobacteriaceae (CPE) are increasingly impacting on patient management and hospital infection control practice. Stem cell transplant patients are among the most susceptible to invasive infections. Here we explored how this cohort are affected by CPE colonizatio...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252848/ http://dx.doi.org/10.1093/ofid/ofy210.1004 |
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author | Ghani, Rohma Mookerjee, Siddharth Mullish, Benjamin Thursz, Mark Marchesi, Julian Pavlu, Jiri Davies, Frances |
author_facet | Ghani, Rohma Mookerjee, Siddharth Mullish, Benjamin Thursz, Mark Marchesi, Julian Pavlu, Jiri Davies, Frances |
author_sort | Ghani, Rohma |
collection | PubMed |
description | BACKGROUND: Carbapenemase producing Enterobacteriaceae (CPE) are increasingly impacting on patient management and hospital infection control practice. Stem cell transplant patients are among the most susceptible to invasive infections. Here we explored how this cohort are affected by CPE colonization. METHODS: All patients who underwent an autologous or allograft stem cell transplant (SCT) between September 15 and December 17 at a large tertiary hospital who were CPE positive on routine rectal screening were reviewed. Length of stay (LoS) post SCT, including readmissions for sepsis and number of days of antibiotics therapy, was assessed. Controls were matched for time and type of SCT in a three controls to one case ratio. T-test was performed to analyze differences between groups (statistical significance attributed when P < 0.05). RESULTS: The case sample had 20 SCT CPE-positive patients, of which allograft (n = 9) and autograft (n = 11). The control sample was made up of 59 SCT CPE-negative patients, allograft (n = 27), and autograft (n = 32). All patients had antibiotic therapy post SCT. Average LoS for the case sample was significantly longer in the autograft group (41.7 vs. 23.6 days, case vs. control, P = 0.01), but not significant in the allograft group (75.1 vs. 58 days, P = 0.12). Both autograft and allograft case samples had significantly longer duration of meropenem therapy, 24.8 vs. 14.4 days for allograft (P = 0.03) and 9.4 vs. 5.5 days for autograft (P = 0.03), cases vs. control. Colistin therapy was longer in both case samples (P = 0.03 in autograft and P = 0.006 in allograft). Tigecycline therapy was significantly longer in the autograft case vs. control sample (P = 0.006), with teicoplanin and piperacillin–tazobactam therapy significantly longer in the autograft case vs. control sample, P = 0.015 and P = 0.03, respectively. CONCLUSION: The LoS post SCT and duration of antibiotic therapy were found to be key proxy measures of worsening outcomes for CPE-positive patients vs. CPE-negative patients who had undergone SCT. Although reasons for CPE colonization vary, there appears to be an overall negative impact on patient outcomes and increased use of more toxic agents, demonstrating the need for early directed CPE decontamination therapy of these at-risk patients, such as use of Faecal Microbiota Transplant (FMT). DISCLOSURES: All authors: No reported disclosures. |
format | Online Article Text |
id | pubmed-6252848 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-62528482018-11-28 1171. Impact on Mortality, Length of Stay, and Antibiotic Use in Allogenic and Autologous Stem Cell Transplant Patients Colonized With Carbapenemase-Producing Enterobacteriaceae Ghani, Rohma Mookerjee, Siddharth Mullish, Benjamin Thursz, Mark Marchesi, Julian Pavlu, Jiri Davies, Frances Open Forum Infect Dis Abstracts BACKGROUND: Carbapenemase producing Enterobacteriaceae (CPE) are increasingly impacting on patient management and hospital infection control practice. Stem cell transplant patients are among the most susceptible to invasive infections. Here we explored how this cohort are affected by CPE colonization. METHODS: All patients who underwent an autologous or allograft stem cell transplant (SCT) between September 15 and December 17 at a large tertiary hospital who were CPE positive on routine rectal screening were reviewed. Length of stay (LoS) post SCT, including readmissions for sepsis and number of days of antibiotics therapy, was assessed. Controls were matched for time and type of SCT in a three controls to one case ratio. T-test was performed to analyze differences between groups (statistical significance attributed when P < 0.05). RESULTS: The case sample had 20 SCT CPE-positive patients, of which allograft (n = 9) and autograft (n = 11). The control sample was made up of 59 SCT CPE-negative patients, allograft (n = 27), and autograft (n = 32). All patients had antibiotic therapy post SCT. Average LoS for the case sample was significantly longer in the autograft group (41.7 vs. 23.6 days, case vs. control, P = 0.01), but not significant in the allograft group (75.1 vs. 58 days, P = 0.12). Both autograft and allograft case samples had significantly longer duration of meropenem therapy, 24.8 vs. 14.4 days for allograft (P = 0.03) and 9.4 vs. 5.5 days for autograft (P = 0.03), cases vs. control. Colistin therapy was longer in both case samples (P = 0.03 in autograft and P = 0.006 in allograft). Tigecycline therapy was significantly longer in the autograft case vs. control sample (P = 0.006), with teicoplanin and piperacillin–tazobactam therapy significantly longer in the autograft case vs. control sample, P = 0.015 and P = 0.03, respectively. CONCLUSION: The LoS post SCT and duration of antibiotic therapy were found to be key proxy measures of worsening outcomes for CPE-positive patients vs. CPE-negative patients who had undergone SCT. Although reasons for CPE colonization vary, there appears to be an overall negative impact on patient outcomes and increased use of more toxic agents, demonstrating the need for early directed CPE decontamination therapy of these at-risk patients, such as use of Faecal Microbiota Transplant (FMT). DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6252848/ http://dx.doi.org/10.1093/ofid/ofy210.1004 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 Ghani, Rohma Mookerjee, Siddharth Mullish, Benjamin Thursz, Mark Marchesi, Julian Pavlu, Jiri Davies, Frances 1171. Impact on Mortality, Length of Stay, and Antibiotic Use in Allogenic and Autologous Stem Cell Transplant Patients Colonized With Carbapenemase-Producing Enterobacteriaceae |
title | 1171. Impact on Mortality, Length of Stay, and Antibiotic Use in Allogenic and Autologous Stem Cell Transplant Patients Colonized With Carbapenemase-Producing Enterobacteriaceae |
title_full | 1171. Impact on Mortality, Length of Stay, and Antibiotic Use in Allogenic and Autologous Stem Cell Transplant Patients Colonized With Carbapenemase-Producing Enterobacteriaceae |
title_fullStr | 1171. Impact on Mortality, Length of Stay, and Antibiotic Use in Allogenic and Autologous Stem Cell Transplant Patients Colonized With Carbapenemase-Producing Enterobacteriaceae |
title_full_unstemmed | 1171. Impact on Mortality, Length of Stay, and Antibiotic Use in Allogenic and Autologous Stem Cell Transplant Patients Colonized With Carbapenemase-Producing Enterobacteriaceae |
title_short | 1171. Impact on Mortality, Length of Stay, and Antibiotic Use in Allogenic and Autologous Stem Cell Transplant Patients Colonized With Carbapenemase-Producing Enterobacteriaceae |
title_sort | 1171. impact on mortality, length of stay, and antibiotic use in allogenic and autologous stem cell transplant patients colonized with carbapenemase-producing enterobacteriaceae |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252848/ http://dx.doi.org/10.1093/ofid/ofy210.1004 |
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