scholarly journals 949. Risk Factors for Subsequent Multidrug-Resistant Gram-Negative Bloodstream Infection Following an Initial Gram-Negative Bloodstream Infection among Solid Organ Transplant Recipients

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S567-S568
Author(s):  
Alyssa Ammazzalorso ◽  
Jennifer Han ◽  
Ebbing Lautenbach ◽  
Pranita Tamma ◽  
Pranita Tamma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bloodstream Infection ◽  
Organ Transplant ◽  
Multidrug Resistant ◽  
Solid Organ ◽  
Scientific Advisory Committee ◽  
Gram Negative ◽  
Material Support ◽  
Extended Spectrum Beta Lactamase ◽  
Carbapenem Resistant

Abstract Background Multidrug-resistant (MDR) Gram-negative (GN) bloodstream infections (BSI) are a major cause of morbidity and mortality among solid organ transplant recipients (SOTR). We determined risk factors associated with subsequent MDR-GN BSI following an initial Enterobacterales (EB) BSI among SOTRs. Methods A retrospective cohort study was performed. All SOTR with an EB BSI at the Hospital of the University of Pennsylvania and University of Maryland Medical Center between 1 Jan 2007 and 30 June 2018 and The Johns Hopkins Hospital between 1 Jan 2005 and 31 Dec 2015 were included. The primary outcome was any MDR-GN BSI within 60 days of the EB BSI, including MDR-EB (defined by ceftriaxone MIC ≥8μg/mL), and MDR-Pseudomonas and Acinetobacter (defined by resistance to three or more antibiotic classes). Unadjusted analyses were performed to identify possible risk factors, using a Fisher’s exact or χ 2 test for categorical and Student’s t-test for continuous variables. Results Of 988 SOTR with an EB BSI, 138 (14%) had a MDR-GN BSI within 60 days. In unadjusted analyses, possible risk factors for a subsequent MDR-GN BSI (Table 1) included: (1) an index BSI due to extended-spectrum beta-lactamase (ESBL)-producing EB (compared to a susceptible index EB BSI); (2) a carbapenem-resistant EB (CRE) index BSI (compared to a susceptible index EB BSI); (3) exposure to piperacillin-tazobactam or carbapenems in the 6 months prior to the index EB BSI; (4) prior liver transplantation; and (5) need for reoperation within four weeks of the original transplantation. There was no significant association between recurrent MDR-GN BSI and immunosuppression at time of infection, induction immunosuppression history, acute rejection history, or primary graft dysfunction. Table 1. Risk factors for subsequent MDR-GN BSI following EB BSI among SOTR. Data are presented as numbers (percentages) except where noted. Abbreviations: BSI, bloodstream infection; CRE, carbapenem-resistant Enterobacterales; EB, Enterobacterales; ESBL, extended-spectrum beta-lactamase; GN, Gram-negative; IQR, interquartile range; MDR, multidrug-resistant Conclusion This study shows that liver transplantation, reoperation following transplantation, an index ESBL-EB or CRE BSI, and recent exposure to broad-spectrum beta-lactam antibiotics are associated with an increased odds of subsequent MDR-GN BSI in SOTR, and underscores the need for future studies aimed at preventing emergence of MDR-GN infections in this vulnerable population. Disclosures Jennifer Han, MD, MSCE, GlaxoSmithKline (Employee, Shareholder) Ebbing Lautenbach, MD, MPH, MSCE, Merck (Other Financial or Material Support, Member of Data and Safety Monitoring Board (DSMB)) Pranita Tamma, MD, MHS, Nothing to disclose Emily Blumberg, MD, Amplyx (Other Financial or Material Support, Member of Data and Safety Monitoring Board (DSMB))Hologic (Research Grant or Support)Merck (Grant/Research Support, Other Financial or Material Support, Member of Scientific Advisory Committee)Takeda (Research Grant or Support, Other Financial or Material Support, Member of Scientific Advisory Committee) Judith A. Anesi, MD, MSCE, Nothing to disclose

Molecular Detection of Carbapenem Resistant Gram Negative Bacterial Isolates from Dogs 

2021 ◽  
Author(s):  
Surya Sankar ◽  
Thresia . ◽  
Anu Bosewell ◽  
M. Mini
Keyword(s):  
Companion Animals ◽  
Multidrug Resistant ◽  
Beta Lactam ◽  
Gram Negative ◽  
Extended Spectrum Beta Lactamase ◽  
Beta Lactam Antibiotics ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene ◽  
Line Of Therapy ◽  
Encoding Genes

Background: Carbapenems are beta-lactam antibiotics that are considered as the last line of therapy against multidrug resistant extended spectrum beta-lactamase. The resistance to carbapenems predominantly through carbapenemase is one of the most important emerging health problems worldwide in the therapy of clinical infections. The objective of the present study is to determine the presence of carbapenemase encoding genes among Gram- negative bacterial spp. associated with clinical infections in dogs. Methods: 30 Escherichia coli, 11 Klebsiella pneumoniae and three Pseudomonas aeruginosa isolated from urine, swabs from lesional skin and anterior vagina of dogs presented with different clinical ailments formed the samples for the study. Polymerase chain reaction was carried out to detect the presence of carbapenemase encoding genes viz., KPC, NDM, OXA, VIM and IMP among the isolates.Result: Out of the 44 Gram- negative isolates tested, 28 (76.3%) were positive for at least one tested carbapenemase gene. The highest frequency of carbapenemase recorded was for NDM followed by OXA-181, KPC, OXA-48 and VIM. Our study identified a high prevalence of carbapenemases among companion animals like dogs which could act as potential source of transmission of these resistance bacteria or their genomes to humans.

scholarly journals Risk factors and outcomes for multidrug-resistant Gram-negative bacilli bacteremia

2017 ◽  
Vol 5 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Swati Patolia ◽  
Getahun Abate ◽  
Nirav Patel ◽  
Setu Patolia ◽  
Sharon Frey
Keyword(s):  
Risk Factors ◽  
Urinary Catheter ◽  
Medical Center ◽  
Demographic Data ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Solid Organ ◽  
Gram Negative ◽  
Source Of Infection

Background: The incidence of multidrug-resistant (MDR) organisms is increasing along with mortality. Identifying risk factors for the development of MDR Gram-negative bacilli (GNB) bacteremia could greatly impact patient care and management. Methods: Data from the electronic health record of patients with GNB over 13-month period were collected at a single university medical center. Baseline demographic data, risk factor, microbiological data, recurrence of bacteremia, and mortality were recorded. Results: A total of 177 patients were included in the analysis. MDR GNB occurred in 46 patients (26%). The mortality rate in the MDR group was 34.8% compared to 13.7% in non-MDR group ( p = 0.002). In multivariate analysis, diabetes mellitus [DM; odds ratio (OR): 2.8, 95% confidence interval (CI): 1–4.88], previous antibiotic use (OR: 2.93, 95% CI: 1.25–6.87), and urinary catheter as a source of infection (OR 5.96, 95% CI: 1.78–19.94) were significant risk factors for the development of MDR GNB. In addition, end-stage liver disease (OR: 3.64, 95% CI: 1.07–12.3), solid organ malignancy (OR: 3.64, 95% CI: 1.25–10.56), intra-abdominal source of infection (OR: 3.66, 95% CI: 1.14–11.73), inappropriate empiric antibiotics (OR 7.59, 95% CI: 1.68–34.34) and urinary catheter as a source of infection (OR 5.68, 95% CI: 1.37–23.5) were significant factors for mortality in patients with MDR GNB. Conclusion: Our study provides important information about the risk factors for the development of MDR GNB bacteremia and helps prognosticate patient with MDR GNB.

scholarly journals 468. Delayed Mortality Among Solid Organ Transplant Recipients Hospitalized for Covid-19: An International Multicenter Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S336-S337
Author(s):  
Madeleine R Heldman ◽  
Olivia S Kates ◽  
Robert M Rakita ◽  
Erika D Lease ◽  
Ajit P Limaye ◽  
...  
Keyword(s):  
Risk Factors ◽  
Research Study ◽  
Organ Transplant ◽  
Scientific Research ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Material Support ◽  
Study Investigator ◽  
Solid Organ Transplant Recipients

Abstract Background Studies of solid organ transplant recipients (SOTr) hospitalized for Covid-19 have focused on short-term outcomes with approximately 30 days of follow-up time. Intermediate-term mortality and associated risk factors for intermediate-term death have not previously been reported. Methods Using data from a multi-center registry, we assessed mortality by 90 days among SOTr hospitalized for Covid-19 between 3/1/2020 and 12/31/2020. Multivariable Cox-proportional hazard models were used to compare risk factors for mortality by 28 and 90 days. Covariates were selected a priori based on known predictors of death in SOTr hospitalized for Covid-19. All patients were followed for 90 days or were censored at the time of death or last clinical contact, if this occurred prior to day 90 after diagnosis. Results Among SOTr hospitalized for Covid-19, 198/979 (20%) died within 90 days of diagnosis and 37/198 (19%) of deaths occurred between days 29 and 90. Risk factors for mortality by day 90 days included age >65 years (1.8, 95% CI 1.3-2.4, P< 0.001), lung transplant (compared to non-lung) (1.6, 95% CI 1.1-2.4, P=0.02), chronic lung disease (2.2, 95% CI 1.5-3.4, P=0.002) and heart failure (1.9, 95% CI 1.2-2.9), which were similar to risk factors reported for 28-day mortality (Table 1). Diagnosis during the second half of 2020 (6/20-12/31/20) was associated with lower mortality by 28 days (aHR 0.7, 95% CI 0.5-1.0, P=0.03) compared to diagnosis during the early half of 2020 (3/1-6/19/20); however, mortality by 90 days was similar in the late and early time periods (aHR 0.9, 95% CI 0.7-1.2, P=0.54). Obesity and mTOR inhibitor use were also associated with death by 28 but not 90 days. Kaplan-Meier survival curves by time period of diagnosis are shown in Figure 1. Table 1. Multivariable Cox-Proportional Hazard Model for Mortality at 28 and 90-days Among Solid Organ Transplant Recipients Hospitalized for Covid-19 (N=979) Figure 1. Survival among SOT recipients hospitalized for Covid-19 by diagnosis time period Vertical tick marks represent censored cases. Early 2020 refers to cases diagnosed between March 1 and June 19, 2020 and late 2020 refers to cases diagnosed between June 20 and December 31, 2020. Conclusion Approximately 20% of deaths among SOTr hospitalized for Covid-19 occurred between days 29 and 90. Future investigations are required to discern the mechanism(s) for the improvement in early, but not late, mortality among SOTr with Covid-19 during the course of the pandemic. Disclosures Madeleine R. Heldman, MD, Cigna Lifesource (Other Financial or Material Support, Speaking honoraria)Thermo Fisher Scientific (Other Financial or Material Support, Speaking honoraria) Olivia S. Kates, MD, Merk (Scientific Research Study Investigator) Ajit P. Limaye, MD, astellas (Scientific Research Study Investigator)CTI (Scientific Research Study Investigator)GSK (Consultant)Johnson&Johnson (Other Financial or Material Support, Adjudication Committee)merck (Consultant, Grant/Research Support, Scientific Research Study Investigator)moderna (Scientific Research Study Investigator)Novartis (Other Financial or Material Support, DMC member)Novo Nordisk (Consultant)

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