scholarly journals 59. Risk Factors for Recurrent Gram-Negative Bacterial Bloodstream Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S40-S41
Author(s):  
Andrew J Bock ◽  
Batu K Sharma-Kuinkel ◽  
Felicia Ruffin ◽  
Michael Mohnasky ◽  
Emily Eichenberger ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bacterial Species ◽  
Bloodstream Infections ◽  
Surgical Service ◽  
Research Support ◽  
Cardiac Device ◽  
Gram Negative ◽  
Material Support ◽  
Black Race ◽  
Cardiac Devices

Abstract Background Gram-negative bacteria bloodstream infections (GNB-BSI) are a significant cause of morbidity and mortality. Recurrent GNB-BSI is an incompletely understood phenomenon. In this study we identify risk factors for recurrent GNB-BSI. Methods Patients with GNB-BSI have been prospectively enrolled into the Bloodstream Infection Biorepository (BSIB) since 2002. From the BSIB, patients with >1 episode of GNB-BSI with the same bacterial species were identified. Chi-Square, Fisher Exact, and a multivariate linear regression models were used to identify clinical risk factors for recurrent GNB-BSI. Paired isolate samples from the initial and the recurrent episode of GNB-BSI in same patient underwent Pulsed Field Gel Electrophoresis (PFGE) to differentiate Relapse (paired isolates identical) from Reinfection (paired isolates different). Results Among the 1,423 unique patients with GNB-BSI enrolled from 2002- 2015, 60 (4.2%) experienced recurrent GNB-BSI with the same bacterial species. Median time to recurrent GNB-BSI was 133 d (IQR: 40-284.75 days). Causes of recurrent-GNB-BSI included Escherichia coli (38%), Klebsiella species (30%), Pseudomonas aeruginosa (12%), and Serratia marcescens (5%) and did not differ from causes of non-recurrent GNB-BSI (Figure 1). Risk factors for recurrent GNB-BSI included Black race (OR: 2.45 [CI: 1.43-4.20]), implanted cardiac device (OR: 2.39 [CI: 1.00-5.07]), and admission to surgical service (OR: 2.16 [CI 1.24-3.75]). Forty-eight isolate-pairs from 43 patients with recurrent GNB-BSI underwent PFGE, relapse occurred in 31 (65%) and reinfection occurred in 17 (35%). Risk factors for GNB-BSI relapse included cardiac device (OR: 3.7 [CI: 1.7-8.3]), and admission to surgical service (OR: 3.7 [CI:1.3-9.4]). Figure 1: Species Breakdown Proportional comparison of the Gram-negative bacterial species identified in patients with recurrent and non-recurrent bloodstream infections. Conclusion Recurrent GNB-BSI is an uncommon complication of GNB-BSI. Recurrent GNB-BSI is most often driven by relapse, as opposed to reinfection, and is associated with associated with black race, implanted cardiac devices and admission to surgical service. Disclosures Vance G. Fowler, Jr., MD, MHS, Achaogen (Consultant)Advanced Liquid Logics (Grant/Research Support)Affinergy (Consultant, Grant/Research Support)Affinium (Consultant)Akagera (Consultant)Allergan (Grant/Research Support)Amphliphi Biosciences (Consultant)Aridis (Consultant)Armata (Consultant)Basilea (Consultant, Grant/Research Support)Bayer (Consultant)C3J (Consultant)Cerexa (Consultant, Other Financial or Material Support, Educational fees)Contrafect (Consultant, Grant/Research Support)Debiopharm (Consultant, Other Financial or Material Support, Educational fees)Destiny (Consultant)Durata (Consultant, Other Financial or Material Support, educational fees)Genentech (Consultant, Grant/Research Support)Green Cross (Other Financial or Material Support, Educational fees)Integrated Biotherapeutics (Consultant)Janssen (Consultant, Grant/Research Support)Karius (Grant/Research Support)Locus (Grant/Research Support)Medical Biosurfaces (Grant/Research Support)Medicines Co. (Consultant)MedImmune (Consultant, Grant/Research Support)Merck (Grant/Research Support)NIH (Grant/Research Support)Novadigm (Consultant)Novartis (Consultant, Grant/Research Support)Pfizer (Grant/Research Support)Regeneron (Consultant, Grant/Research Support)sepsis diagnostics (Other Financial or Material Support, Pending patent for host gene expression signature diagnostic for sepsis.)Tetraphase (Consultant)Theravance (Consultant, Grant/Research Support, Other Financial or Material Support, Educational fees)Trius (Consultant)UpToDate (Other Financial or Material Support, Royalties)Valanbio (Consultant, Other Financial or Material Support, Stock options)xBiotech (Consultant)

scholarly journals 1104. Risk Factors and Outcomes of Refractory and/or Resistant Cytomegalovirus (CMV) Infection after Allogeneic Hematopoietic Stem Cell Transplantation

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S582-S583
Author(s):  
Eleni Karantoni ◽  
Yiqi Su ◽  
Anat Stern ◽  
Phaedon D Zavras ◽  
Sergio Giralt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
T Cell ◽  
Panel Member ◽  
Multivariable Model ◽  
Research Support ◽  
Review Panel ◽  
Material Support ◽  
Advisory Boards ◽  
Research Grant

Abstract Background The epidemiology of CMV end-organ disease (EOD) after Hematopoietic Cell Transplant (HCT) in the era of preemptive therapy (PET) is defined. In contrast, less data exists on refractory and/or resistant (R/R) CMV. We report on 1) the incidence; 2) risk factors and outcomes of R/R CMV by 1-year post HCT. Methods Retrospective review of 167 CMV seropositive (R+) recipients of first marrow or peripheral blood HCT from 1/2014 - 12/2017 managed by PET. Refractory CMV was defined as failure to achieve >1 log10 decrease in CMV viral load (VL) and having VL >1,000 IU/mL after ≥14 day of PET. Resistant CMV required genotypic confirmation of resistance mutation(s) in UL54 and/or UL97 genes. End organ disease (EOD) was defined by standard criteria. Patients (pts) were followed through 1-year post HCT and were categorized in two mutually exclusive groups as R/R and no R/R. Demographics, clinical characteristics and outcomes were extracted from medical records and hospital databases. Univariable and multivariable logistic models were used to identify risk factors for R/R CMV. Results Of 167 PET recipients, 91 (54.5%) received ex vivo T cell depleted (TCD) HCT; 40 (24.0%) had mismatched donor; and 26 (15.6%) had multiple myeloma. 66/167 (39.5%) pts developed refractory CMV (6 pts also had resistant CMV). Time from HCT to CMV viremia was shorter in R/R group: median (IQR) 21.5 (17.2-27.8) days compared to no R/R group: 26 (19-32) days (p=0.031). Maximum VL was higher for R/R compared to no R/R: median (IQR) 9,118 (2,849-18,456) and 868 (474-1,908), respectively (p< 0.001). In multivariable model, risk factors for R/R included TCD HCT (p< 0.0001) and higher VL at PET initiation (p=0.0002). In contrast, CMV seropositive donor (p=0.035) was protective (Figure 1). CMV EOD developed in 28.2% of R/R and 16.2% of no R/R groups (p=0.085) (Figure 2). Overall survival at 1 year was 59.1% for R/R compared to 83.1% for no R/R group (p=0.00027) (Figure 3). Figure 1. Adjusted odds ratio (OR) and 95% confidence interval (CI) from multivariable model evaluating risk factors of refractory/resistant (R/R) CMV. Figure 2. Cumulative incidence curves of CMV end-organ disease (EOD) at 1-year post HCT Figure 3. Kaplan-Meier survival curves of overall survival (OS) at 1-year post HCT Conclusion 1) Refractory and/or resistant CMV occurred in 39,5% of PET recipients. 2) T-cell depletion and higher CMV VL at PET initiation were risk factors for R/R CMV in multivariable models. 3) R/R CMV was associated with more EOD and worse overall survival. Disclosures Sergio Giralt, MD, Amgen (Advisor or Review Panel member, Research Grant or Support, Served an advisory board for Amgen, Actinuum, Celgene, Johnson & Johnson, JAZZ pharmaceutical, Takeda, Novartis, KITE, and Spectrum pharma and has received research support from Amgen, Actinuum, Celgene, Johnson & Johnson, and Miltenyi, Takeda.) Miguel-Angel Perales, MD, Abbvie (Other Financial or Material Support, Honoraria from Abbvie, Bellicum, Celgene, Bristol-Myers Squibb, Incyte, Merck, Novartis, Nektar Therapeutics, Omeros, and Takeda.)ASTCT (Other Financial or Material Support, Volunteer member of the Board of Directors of American Society for Transplantation and Cellular Therapy (ASTCT), Be The Match (National Marrow Donor Program, NMDP), and the CIBMTR Cellular Immunotherapy Data Resource (CIDR) Committee)Cidara Therapeutics (Advisor or Review Panel member, Other Financial or Material Support, Serve on DSMBs for Cidara Therapeutics, Servier and Medigene, and the scientific advisory boards of MolMed and NexImmune.)Kite/Gilead (Research Grant or Support, Other Financial or Material Support, Received research support for clinical trials from Incyte, Kite/Gilead and Miltenyi Biotec.) Genovefa Papanicolaou, MD, Chimerix (Research Grant or Support)Merck&Co (Research Grant or Support, Investigator and received funding and consulting fees from Merck, Chimerix, Shire and Astellas)

Impact of empirical antibiotic regimens on mortality in neutropenic patients with bloodstream infection presenting with septic shock

2021 ◽  
Author(s):  
Mariana Chumbita ◽  
Pedro Puerta-Alcalde ◽  
Carlota Gudiol ◽  
Nicole Garcia-Pouton ◽  
Júlia Laporte-Amargós ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Kidney Injury ◽  
Bloodstream Infections ◽  
Gram Positive ◽  
Gram Negative ◽  
Neutropenic Patients ◽  
Prospective Cohorts ◽  
Independent Risk Factors ◽  
The Impact

Objectives: We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. Methods: Multicenter retrospective study (2010-2019) of two prospective cohorts comparing BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Results: Of 1563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% vs 15%, p<0.001). Gram-negative bacilli caused 81% of episodes with septic shock; gram-positive cocci, 22%; and Candida species 5%. Inappropriate empirical antibiotic treatment (IEAT) was administered in 17.5% of septic shock episodes. Empirical β-lactam combined with other active antibiotics was associated with the lowest mortality observed. When amikacin was the only active antibiotic, mortality was 90%. Addition of empirical specific gram-positive coverage had no impact on mortality. Mortality was higher when IEAT was administered (76% vs 51%, p=0.002). Age >70 years (OR 2.3, 95% CI 1.2-4.7), IEAT for Candida spp. or gram-negative bacilli (OR 3.8, 1.3-11.1), acute kidney injury (OR 2.6, 1.4-4.9) and amikacin as the only active antibiotic (OR 15.2, 1.7-134.5) were independent risk factors for mortality, while combination of β-lactam and amikacin was protective (OR 0.32, 0.18-0.57). Conclusions: Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes.

Gram-negative bloodstream infections and sepsis: risk factors, screening tools and surveillance

2019 ◽  
Vol 132 (1) ◽  
pp. 5-15
Author(s):  
Eleanor Mitchell ◽  
Mark S Pearce ◽  
Anthony Roberts
Keyword(s):  
Risk Factors ◽  
Bloodstream Infections ◽  
Screening Tools ◽  
Topic Area ◽  
Gram Negative ◽  
Sepsis Risk ◽  
Comorbidity Scores ◽  
Associated Risk Factors ◽  
The Uk ◽  
Healthcare Associated

Abstract Introduction and background Incidence of gram-negative bloodstream infections (GNBSIs) and sepsis are rising in the UK. Healthcare-associated risk factors have been identified that increase the risk of infection and associated mortality. Current research is focused on identifying high-risk patients and improving the methods used for surveillance. Sources of data Comprehensive literature search of the topic area using PubMed (Medline). Government, professional and societal publications were also reviewed. Areas of agreement A range of healthcare-associated risk factors independently associate with the risk of GNBSIs and sepsis. Areas of controversy There are calls to move away from using simple comorbidity scores to predict the risk of sepsis-associated mortality, instead more advanced multimorbidity models should be considered. Growing points and areas for developing research Advanced risk models should be created and evaluated for their ability to predict sepsis-associated mortality. Investigations into the accuracy of NEWS2 to predict sepsis-associated mortality are required.

scholarly journals Risk Factors for Bloodstream Infections due to Multidrug-resistant Gram-negative Non-fermenting Bacteria in a Burn Unit

2008 ◽  
Vol 12 ◽  
pp. S39-S40
Author(s):  
Süheyla Senger ◽  
Funda Timurkaynak ◽  
Hande Arslan ◽  
Turhan Togan ◽  
Özgür Başaran ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Gram Negative ◽  
Burn Unit ◽  
Fermenting Bacteria

scholarly journals The Risk of Cardiac Device-Related Infection in Bacteremic Patients Is Species Specific: Results of a 12-Year Prospective Cohort

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Stacey A Maskarinec ◽  
Joshua T Thaden ◽  
Derek D Cyr ◽  
Felicia Ruffin ◽  
Maria Souli ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Prospective Cohort ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Cardiac Device ◽  
Gram Negative ◽  
Cardiac Devices ◽  
Increased Risk ◽  
Species Specific

Abstract Background The species-specific risk of cardiac device-related infection (CDRI) among bacteremic patients is incompletely understood. Methods We conducted a prospective cohort study of hospitalized patients from October 2002 to December 2014 with a cardiac device (CD) and either Staphylococcus aureus bacteremia (SAB) or Gram-negative bacteremia (GNB). Cardiac devices were defined as either prosthetic heart valves (PHVs), including valvular support rings, permanent pacemakers (PPMs)/automatic implantable cardioverter defibrillators (AICDs), or left ventricular assist devices (LVADs). Results During the study period, a total of 284 patients with ≥1 CD developed either SAB (n = 152 patients) or GNB (n = 132 patients). Among the 284 patients, 150 (52.8%) had PPMs/AICDs, 72 (25.4%) had PHVs, 4 (1.4%) had LVADs, and 58 (20.4%) had &gt;1 device present. Overall, 54.6% of patients with SAB and 16.7% of patients with GNB met criteria for definite CDRI (P &lt; .0001). Multivariable logistic regression analysis revealed that 3 bacterial species were associated with an increased risk for CDRI: Staphylococcus aureus (odds ratio [OR] = 5.57; 95% confidence interval [CI], 2.16–14.36), Pseudomonas aeruginosa (OR = 50.28; 95% CI, 4.16–606.93), and Serratia marcescens (OR = 7.75; 95% CI, 1.48–40.48). Conclusions Risk of CDRI among patients with bacteremia varies by species. Cardiac device-related infection risk is highest in patients with bacteremia due to S aureus, P aeruginosa, or S marcescens. By contrast, it is lower in patients with bacteremia due to other species of Gram-negative bacilli. Patients with a CD who develop bacteremia due to either P aeruginosa or S marcescens should be considered for diagnostic imaging to evaluate for the presence of CDRI.

scholarly journals 297. Infectious Complications Associated with Tocilizumab Use in Patients Infected with SARS-CoV-2 at a Mid-Atlantic Hospital Consortium

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S256-S256
Author(s):  
Kristen R Kent ◽  
Nellie Darling ◽  
Xue Geng ◽  
Gavin Clark ◽  
Marybeth Kazanas ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Post Treatment ◽  
Risk Of Infection ◽  
Research Support ◽  
Candida Spp ◽  
Gram Positive ◽  
Gram Negative ◽  
Material Support ◽  
Increased Risk ◽  
Significant Difference

Abstract Background The IL-6 inhibitor Tocilizumab (TOCI) has been associated with infections in 5-8% of patients with Rheumatoid Arthritis. TOCI has now been recommended as a treatment option for select patients with COVID-19; however, the risk of infection in this patient population is yet to be determined. Methods We performed a retrospective chart review of patients diagnosed with COVID-19 and admitted to MedStar hospitals within the D.C./Baltimore corridor from 03/01/2020 to 12/31/2020. We identified patients who had positive culture data within 30 days of administration of TOCI-based regimens and analyzed clinical characteristics and outcomes. Univariate analyses (Wilcoxon, T-test, Chi-Square, Fisher’s Exact) were used to compare these outcome variables between patients who had post-treatment infections and those who did not. Results A total of 220 patients received TOCI-based regimens; 16% (N=36) of patients developed positive cultures within 30 days of treatment. Of the 99 cultures, 50% were gram positive (N=49), 38% were gram negative (N=38), 10% were Candida spp. (N=10), and 2% were anaerobic organisms (N=2). Only 9% (8/87) of the gram positive and gram negative organisms were MDROs. Bloodstream infections were the most common and accounted for 58.4% of all infections. Length of stay (LOS) was approximately twice as long in those with post-treatment infections (26 days) compared to those without infections (14 days, p&lt; 0.001). Although the mortality rate was higher in patients with infections after TOCI-based treatment compared to patients with no post-treatment infection (47% vs 31% respectively), this did not reach statistical significance (p=0.09). Moreover, there was no significant difference in the infection rate of patients treated with TOCI alone compared to TOCI and Dexamethasone (16.6% vs. 13.3%, p=0.99). No cases of invasive Aspergillosis were observed. Conclusion Tocilizumab treatment in patients with COVID-19 may predispose patients to an increased risk of infection which is associated with a prolonged LOS and possibly higher mortality. We observed a two-fold increase in infections in COVID-19 patients compared to other patient groups receiving this treatment. Disclosures Princy N. Kumar, MD, AMGEN (Other Financial or Material Support, Honoraria)Eli Lilly (Grant/Research Support)Gilead (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)GSK (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)Merck & Co., Inc. (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)

scholarly journals Risk Factors of Bloodstream Infections Caused by Carbapenem-resistant Gram-negative Pathogens in Pediatric Critical Care Settings

2019 ◽  
Vol 6 (3) ◽  
pp. 180-185
Author(s):  
Zümrüt Şahbudak Bal ◽  
Muhterem Duyu ◽  
Fulya Kamit ◽  
Pınar Yazıcı ◽  
Ayşe Berna Anıl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Bloodstream Infections ◽  
Pediatric Critical Care ◽  
Gram Negative ◽  
Carbapenem Resistant

scholarly journals 181. Demographic and Geographic Epidemiology of Staphylococcus aureus Bacteremia using Geographic Information Systems Mapping and Spatial Statistics

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S199-S199
Author(s):  
Julia Marshall ◽  
Vance G Fowler ◽  
Felicia Ruffin ◽  
Paul Lantos ◽  
Christopher Timmins
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Information Systems ◽  
Geographic Information Systems ◽  
Spatial Statistics ◽  
Clinical Characteristics ◽  
Geographic Information ◽  
Research Support ◽  
Material Support ◽  
Staphylococcus Aureus Bacteremia

Abstract Background Risk factors for community-associated Staphylococcus aureus bacteremia (SAB) are incompletely understood. We used Geographic Information Systems (GIS) and spatial statistics to analyze demographic and geographic epidemiology of SAB in the community. Methods We used the S. aureus Bacteremia Group Prospective Cohort Study (SABG-PCS) at Duke University Medical Center to obtain demographic and clinical data. We used the American Community Survey and U.S. Census to supply neighborhood variables. Secular trends in demographic and clinical characteristics of SAB patients prospectively enrolled between 1995 and 2015 (n = 2478) were determined using linear regressions. To characterize spatial patterns in Methicillin-resistant S. aureus (MRSA) bacteremia compared to Methicillin-susceptible S. aureus (MSSA) bacteremia, we used GIS mapping and selected a subgroup of patients (n = 667) living in and around Durham County, North Carolina. We then created generalized additive models (GAMs) using this subgroup to detect geographic heterogeneities in probabilities of MRSA infections compared to MSSA infections. Results We found evidence of changing demographic and clinical characteristics of SAB patients over the 21-year period. The proportion of infections acquired in the community increased significantly (p &lt; 0.0001). However, we did not detect spatial heterogeneities of MRSA infections in Durham County. Patient location of residence was not significantly associated with antimicrobial-resistant infections. Patient age and year of hospital admission were the only statistically significant covariates in our spatial models. Conclusion We utilized a novel method to analyze SAB in the community using GIS and spatial statistics. Future research should prioritize community transmission of S. aureus to identify robust risk factors for infection. Disclosures Vance G. Fowler, Jr., MD, MHS, Achaogen (Consultant)Advanced Liquid Logics (Grant/Research Support)Affinergy (Consultant, Grant/Research Support)Affinium (Consultant)Akagera (Consultant)Allergan (Grant/Research Support)Amphliphi Biosciences (Consultant)Aridis (Consultant)Armata (Consultant)Basilea (Consultant, Grant/Research Support)Bayer (Consultant)C3J (Consultant)Cerexa (Consultant, Other Financial or Material Support, Educational fees)Contrafect (Consultant, Grant/Research Support)Debiopharm (Consultant, Other Financial or Material Support, Educational fees)Destiny (Consultant)Durata (Consultant, Other Financial or Material Support, educational fees)Genentech (Consultant, Grant/Research Support)Green Cross (Other Financial or Material Support, Educational fees)Integrated Biotherapeutics (Consultant)Janssen (Consultant, Grant/Research Support)Karius (Grant/Research Support)Locus (Grant/Research Support)Medical Biosurfaces (Grant/Research Support)Medicines Co. (Consultant)MedImmune (Consultant, Grant/Research Support)Merck (Grant/Research Support)NIH (Grant/Research Support)Novadigm (Consultant)Novartis (Consultant, Grant/Research Support)Pfizer (Grant/Research Support)Regeneron (Consultant, Grant/Research Support)sepsis diagnostics (Other Financial or Material Support, Pending patent for host gene expression signature diagnostic for sepsis.)Tetraphase (Consultant)Theravance (Consultant, Grant/Research Support, Other Financial or Material Support, Educational fees)Trius (Consultant)UpToDate (Other Financial or Material Support, Royalties)Valanbio (Consultant, Other Financial or Material Support, Stock options)xBiotech (Consultant)

Clinical Experience with Aminoglycosides in Dialysis-Dependent Patients: Risk Factors for Mortality and Reassessment of Current Dosing Practices

2011 ◽  
Vol 45 (11) ◽  
pp. 1338-1345 ◽  
Author(s):  
Brett H Heintz ◽  
George R Thompson ◽  
William E Dager
Keyword(s):  
Risk Factors ◽  
Average Duration ◽  
Bloodstream Infections ◽  
Optimal Dose ◽  
Empiric Therapy ◽  
Multidrug Resistant ◽  
Gram Negative ◽  
Factors Associated ◽  
Aminoglycoside Therapy ◽  
Increased Risk

Background:: A resurgence of aminoglycoside use has followed the recent increase of multidrug-resistant gram-negative pathogens and is often needed even in the treatment of dialysis-dependent patients; however, studies evaluating the treatment of gram-negative infections with aminoglycosides, including the optimal dose, in the setting of dialysis are limited. Objective: To evaluate the current patterns of aminoglycoside use, including microbiologic and clinical indications, and identify risk factors associated with mortality in dialysis-dependent patients receiving aminoglycosides. Methods: Utilization, clinical, and microbiologic data were collected retrospectively over a 2-year period (July 2008-June 2010) for adults with a diagnosis of renal failure requiring dialysis and aminoglycoside therapy. Binary logistic and multivariate regression analyses were performed to identify risk factors for alt-cause 30-day mortality. Results: Ninety-five consecutive aminoglycoside courses in 88 patients met inclusion criteria for evaluation. A wide variety of clinical and microbiologic indications were documented. The average duration of aminoglycoside therapy was 5.2 days (range 1-42), the average duration of antimicrobial therapy was 13.5 days (1-60), and the all-cause 30-day mortality rate was 36.5%. Factors associated with all-cause 30-day mortality were gram-negative rod (GNR) bacteremia (OR 28.6; p = 0.035), advanced age (OR 8.5; p = 0.030), recent admission (OR 33.4; p = 0.038). and inadequate empiric therapy (OR 14.9; p = 0.024). Intravenous catheter removal was protective of all-cause 30-day mortality (OR 0.01; p = 0.005). A first pre-dialysis plasma concentration relative to the minimum inhibitory concentration (Cp:MIC) <6 mg/L (gentamicin/tobramycin) was associated with an increased risk of mortality (p = 0.026) upon subgroup analysis of dialysis-dependent patients with GNR bloodstream infections. Conclusions: Outcomes among dialysis-dependent patients who received aminoglycosides were below expectations. Various risk factors for mortality were identified, including retention of the catheter, inadequate empiric therapy, and a Cp:MIC <6 mg/L. Improved approaches to dosing of aminoglycosides in dialysis-dependent patients, including more aggressive dosing practices, should be urgently explored in attempts to maximize favorable patient outcomes.

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