Cargando…

2431. Evaluation of Clinical Outcomes in Bacteremia Due to AmpC β-Lactamase Producing Organisms Stratified by Treatment

BACKGROUND: Enterobacteriaceae and Pseudomonas aeruginosa are common bloodstream pathogens with variable AmpC β-lactamase (AmpC) incidence. The clinical utility of treatment with non-carbapenem/cefepime options remains unclear. The objective of this study was to compare the clinical outcomes for pat...

Descripción completa

Detalles Bibliográficos
Autores principales: Carlson, Travis, Phe, Kady, Russo, Hannah Palmer
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253892/
http://dx.doi.org/10.1093/ofid/ofy210.2084
_version_ 1783373598443962368
author Carlson, Travis
Phe, Kady
Russo, Hannah Palmer
author_facet Carlson, Travis
Phe, Kady
Russo, Hannah Palmer
author_sort Carlson, Travis
collection PubMed
description BACKGROUND: Enterobacteriaceae and Pseudomonas aeruginosa are common bloodstream pathogens with variable AmpC β-lactamase (AmpC) incidence. The clinical utility of treatment with non-carbapenem/cefepime options remains unclear. The objective of this study was to compare the clinical outcomes for patients receiving a carbapenem or cefepime (CC) and alternative therapy (AT) for bacteremia caused by organisms known to produce AmpC. METHODS: Hospitalized adults with a confirmed mono-microbial bacteremia admitted from June 2016 to December 2017 were included. Patients were stratified by definitive therapy (DT) with CC or AT. The AT group was treated with fluoroquinolones, third-generation cephalosporins, piperacillin–tazobactam, aztreonam, or tobramycin. The primary outcome was in-hospital mortality. Secondary outcomes included treatment failure, microbiological failure, hospital length of stay (LOS), and intensive care unit LOS. Multiple regression analysis was used to adjust for potential confounding variables. RESULTS: Of 68 patients meeting eligibility criteria, 46% received CC for DT. Enterobacteriaceae were isolated in 45% of patients in the CC group. In-hospital mortality was 32% and 3% (P = 0.0017) in the CC and AT groups, respectively. Source control, APACHE II score on the date of index culture, and immune status did not differ between groups. Definitive CC therapy was independently associated with mortality (odds ratio, 15.17; 95% confidence interval, 1.69–135.76; P = 0.0150). Only 6 (9%) patients received AT as empiric and DT. Those who received definitive AT received a median of 5 days (interquartile range, 3–9 days) of CC prior to being switched to AT. CONCLUSION: While most patients received empiric CC, definitive treatment with CC was found to be an independent predictor of in-hospital mortality. These findings suggest that AT may be a de-escalation treatment strategy for clinicians to consider. However, these results should be confirmed in a larger population. DISCLOSURES: All authors: No reported disclosures.
format Online
Article
Text
id pubmed-6253892
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-62538922018-11-28 2431. Evaluation of Clinical Outcomes in Bacteremia Due to AmpC β-Lactamase Producing Organisms Stratified by Treatment Carlson, Travis Phe, Kady Russo, Hannah Palmer Open Forum Infect Dis Abstracts BACKGROUND: Enterobacteriaceae and Pseudomonas aeruginosa are common bloodstream pathogens with variable AmpC β-lactamase (AmpC) incidence. The clinical utility of treatment with non-carbapenem/cefepime options remains unclear. The objective of this study was to compare the clinical outcomes for patients receiving a carbapenem or cefepime (CC) and alternative therapy (AT) for bacteremia caused by organisms known to produce AmpC. METHODS: Hospitalized adults with a confirmed mono-microbial bacteremia admitted from June 2016 to December 2017 were included. Patients were stratified by definitive therapy (DT) with CC or AT. The AT group was treated with fluoroquinolones, third-generation cephalosporins, piperacillin–tazobactam, aztreonam, or tobramycin. The primary outcome was in-hospital mortality. Secondary outcomes included treatment failure, microbiological failure, hospital length of stay (LOS), and intensive care unit LOS. Multiple regression analysis was used to adjust for potential confounding variables. RESULTS: Of 68 patients meeting eligibility criteria, 46% received CC for DT. Enterobacteriaceae were isolated in 45% of patients in the CC group. In-hospital mortality was 32% and 3% (P = 0.0017) in the CC and AT groups, respectively. Source control, APACHE II score on the date of index culture, and immune status did not differ between groups. Definitive CC therapy was independently associated with mortality (odds ratio, 15.17; 95% confidence interval, 1.69–135.76; P = 0.0150). Only 6 (9%) patients received AT as empiric and DT. Those who received definitive AT received a median of 5 days (interquartile range, 3–9 days) of CC prior to being switched to AT. CONCLUSION: While most patients received empiric CC, definitive treatment with CC was found to be an independent predictor of in-hospital mortality. These findings suggest that AT may be a de-escalation treatment strategy for clinicians to consider. However, these results should be confirmed in a larger population. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6253892/ http://dx.doi.org/10.1093/ofid/ofy210.2084 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
Carlson, Travis
Phe, Kady
Russo, Hannah Palmer
2431. Evaluation of Clinical Outcomes in Bacteremia Due to AmpC β-Lactamase Producing Organisms Stratified by Treatment
title 2431. Evaluation of Clinical Outcomes in Bacteremia Due to AmpC β-Lactamase Producing Organisms Stratified by Treatment
title_full 2431. Evaluation of Clinical Outcomes in Bacteremia Due to AmpC β-Lactamase Producing Organisms Stratified by Treatment
title_fullStr 2431. Evaluation of Clinical Outcomes in Bacteremia Due to AmpC β-Lactamase Producing Organisms Stratified by Treatment
title_full_unstemmed 2431. Evaluation of Clinical Outcomes in Bacteremia Due to AmpC β-Lactamase Producing Organisms Stratified by Treatment
title_short 2431. Evaluation of Clinical Outcomes in Bacteremia Due to AmpC β-Lactamase Producing Organisms Stratified by Treatment
title_sort 2431. evaluation of clinical outcomes in bacteremia due to ampc β-lactamase producing organisms stratified by treatment
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253892/
http://dx.doi.org/10.1093/ofid/ofy210.2084
work_keys_str_mv AT carlsontravis 2431evaluationofclinicaloutcomesinbacteremiaduetoampcblactamaseproducingorganismsstratifiedbytreatment
AT phekady 2431evaluationofclinicaloutcomesinbacteremiaduetoampcblactamaseproducingorganismsstratifiedbytreatment
AT russohannahpalmer 2431evaluationofclinicaloutcomesinbacteremiaduetoampcblactamaseproducingorganismsstratifiedbytreatment