226. Nine-year Survey of Bloodstream Infections (BSIs) across Six Types of Solid-organ Transplant (SOT) at a Large University Medical Center

BACKGROUND: BSIs are common in SOT patients. We surveyed BSIs across 6 types of SOT over 9 years at our center. METHODS: We conducted a retrospective study of BSI among patients transplanted from January 2010 to January 2019. Single blood cultures positive for coagulase-negative staphylococci, Corynebacterium, Bacillus, or Propionibacterium were excluded. RESULTS: 3,358 patients underwent SOT, including kidney (K, 43%, 1432), lung (Lu, 23%, 778), liver (Li, 21%, 700), heart (H, 8%, 256), pancreas (P, 4%, 149), and small bowel/multivisceral (SB/MV 1%, 43). 16% (529) of patients had ≥1 episode of BSI. There were 770 BSIs; 14% (105/770) were recurrent. Median number of BSI was 1/patient (range: 1 to 7). BSI rates were highest among SB/MV patients (53%), followed by Lu (22%), Li (20%), P (15%), H (14%) and K patients (14%) (Figure 1). 20% (156), 24% (187) and 7% (52) of BSI occurred at ≤30 d, 31–180 d, and 181–365 d after SOT, respectively. BSI rates at ≤ and >180 d post-SOT were 3.6 and 0.65/1000 pt-d, respectively (P < 0.0001). Most common bacteria were Enterobacteriaceae (35%) and Enterococcus spp. (22%). Candida spp. accounted for 6% (49/770) of BSIs. Enterobactericeae were most common among intra-abdominal SOT patients, whereas Enterococcus and non-fermenting Gram-negatives were most common in Lu patients (Figure 2). 8% (65) of BSI was polymicrobial. From 2016 to 2018, 15% (14/96) of Enterobacteriaceae BSIs were multi-drug-resistant (MDR); 8% (8/96) were extensively drug resistant (XDR). 23% (3/13) of P. aeruginosa were MDR (all XDR). 70% (14/20) and 5% (1/20) of E. faecium and E. faecalis were vancomycin-resistant, respectively. Thirty-day mortality following BSI diagnosis was highest for H (31%), followed by Lu (15%), Li (10%), P (9%) and SB/MV (4%) patients. Patients with bacteremia had higher mortality than patients with no bacteremia (Figure 3). CONCLUSION: BSIs are common after SOT, and associated with significant short- and long-term mortality. Almost half of BSIs occur within the first 6 months of SOT, when BSI rates are significantly higher than at later time points. Predominant BSI pathogens differ between SOT types; as such, empiric antimicrobial therapy decisions should be organ-specific. At our center, MDR and XDR Gram-negative bacteria and VRE are common; centers should use overall SOT and organ-specific antibiograms to drive empiric antimicrobial strategies. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.