scholarly journals Comparison of 30- and 90-Day Mortality Rates in Patients with Cultures Positive for Carbapenem-resistant Enterobacteriaceae and Acinetobacter in Atlanta, 2011–2015

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S44-S44
Author(s):  
Mary Elizabeth Sexton ◽  
Chris Bower ◽  
Stephen Sukumaran ◽  
Jesse T Jacob
Keyword(s):  
Survival Analysis ◽  
Acinetobacter Baumannii ◽  
Mortality Rates ◽  
Vital Statistics ◽  
Rank Test ◽  
Invasive Infection ◽  
Emerging Infections ◽  
Carbapenem Resistant ◽  
Invasive Infections ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) and Acinetobacter baumannii (CRAB) pose a threat to public health, but comparisons of disease burden are limited. We compared survival in patients following cultures positive for CRE or CRAB. Methods The Georgia Emerging Infections Program performs active population-based and laboratory-based surveillance for CRE and CRAB in metropolitan Atlanta, GA. Using standard CDC definitions, we included patients who had incident carbapenem-nonsusceptible E. coli, Klebsiella spp., Enterobacter spp., or Acinetobacter baumannii isolated from urine only (noninvasive infection) or a sterile site (invasive infection) between 8/2011 and 12/2015. Death dates, verified by Georgia Vital Statistics records, were used to calculate 30- and 90-day mortality rates. We used the chi-square test for mortality rates and the log-rank test for survival analysis to 90 days to compare patients with invasive CRAB, noninvasive CRAB, invasive CRE, and noninvasive CRE. Results There were 535 patients with CRE (87 invasive, 448 noninvasive) and 279 (78 invasive, 201 noninvasive) with CRAB. Nearly all patients with CRE and CRAB had healthcare exposures (97.2% vs. 100%) and most were immunosuppressed (62.6% vs. 56.3%). Both 30-day (24.4% vs. 18.3%, p = 0.04) and 90-day (37.6% vs. 30.5%, p = 0.04) mortality were higher in patients with CRAB than CRE. Patients with invasive infections were more likely to die at 90 days than those with noninvasive infections (53.3% vs. 38.4%, p < 0.0001). Overall mortality rates for invasive infection were similar between CRAB and CRE at 30 (44.9% vs. 34.5% p = 0.2) and 90 days (59.0% vs. 48.3%, p = 0.2). Using survival analysis at 90 days, invasive CRAB had the worst outcomes, followed by invasive CRE, noninvasive CRAB and noninvasive CRE 
(p < 0.0001, see Figure). Conclusion Ninety -day mortality for invasive infections with CRE and CRAB was ~50%, and patients with CRAB had lower survival than those with CRE, suggesting that prevention efforts may need to prioritize CRAB as highly as CRE in facilities with endemic CRAB. With the high proportion of healthcare exposures and immunosuppression, these infections may signify poor prognosis or directly contribute to mortality. Disclosures All authors: No reported disclosures.

scholarly journals Carbapenem-Resistant Enterobacteriaceae Resistant Only to Ertapenem: An Epidemiologically Distinct Cohort, Atlanta, 2016–2018

2020 ◽  
Vol 41 (S1) ◽  
pp. s463-s464
Author(s):  
Chris Bower ◽  
Max Adelman ◽  
Jessica Howard-Anderson ◽  
Uzma Ansari ◽  
Joseph Lutgring ◽  
...  
Keyword(s):  
Public Health ◽  
Clinical Laboratory ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Vital Statistics ◽  
Emerging Infections ◽  
Term Care ◽  
Convenience Sample ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Background: Carbapenem-resistant Enterobacteriaceae (CRE), particularly carbapenemase-producing (CP) CRE, pose a major public health threat. In 2016, the phenotypic definition of CRE expanded to include ertapenem resistance to improve sensitivity for detecting CP-CRE. We compared characteristics of CRE resistant to ertapenem only (CRE-EO) to CRE resistant to ≥1 other carbapenem (CRE-O). Methods: The Georgia Emerging Infections Program performs active, population-based CRE surveillance in metropolitan Atlanta. CRE cases were defined as any Escherichia coli, Klebsiella pneumoniae, K. oxytoca, K. variicola, Enterobacter cloacae complex, or Enterobacter aerogenes resistant to ≥1 carbapenem by the clinical laboratory and isolated from urine or a sterile site between 2016 and 2018. Data were extracted from retrospective chart review and 90-day mortality from Georgia vital statistics for 2016–2017. Polymerase chain reaction (PCR) for carbapenemase genes was performed on a convenience sample of isolates by the CDC or Georgia Public Health Laboratory. We compared characteristics of CRE-EO cases to CRE-O cases using χ2 tests or t tests. Results: Among 927 CRE isolates, 553 (60%) were CRE-EO. CRE-EO were less frequently isolated from blood (5% vs 12%; P < .01) and less commonly K. pneumoniae (21% vs 58%; P < .01) than CRE-O. CRE-EO cases were more often women (65% vs 50%; P < .01), had a lower Charlson comorbidity index (mean ± SD, 2.4±2.3 vs 3.0±2.6; P < .01), and were less commonly at a long-term care facility (24% vs 31%) or hospital (15% vs 21%; P < .01) in the 4 days prior to the CRE culture. CRE-EO were more susceptible to all antibiotics tested at the clinical laboratory (P < .01) except for tigecycline (P = 1.0) (Table 1). Of the 300 (32%) isolates tested for carbapenemase genes, 98 (33%) were positive (7% CRE-EO vs 62% CRE-O; P < .01). Of the CP isolates, we identified blaKPC in 93 cases (95%), blaNDM in 3 cases (3%), blaOXA-48-like in 2 cases (2%). CRE-EO cases had lower 90-day mortality (13% vs 21%; P < .01). Conclusions: CRE-EO are epidemiologically distinct from CRE-O and are less likely to harbor carbapenemase genes. CRE-EO may require less intensive infection prevention interventions and have more therapeutic options.Funding: NoneDisclosures: None

scholarly journals 1250. Prevalence and Risk Factors for Acquiring Carbapenem-Resistant Enterobacteriaceae in an Intensive Care Unit at a Tertiary Hospital

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S380-S380
Author(s):  
Jin Suk Kang ◽  
Soon Ok Lee ◽  
Jeong Eun Lee ◽  
So Ra Kim ◽  
Han Wool Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Common Species ◽  
Tertiary Hospital ◽  
Multidrug Resistant ◽  
Invasive Infection ◽  
Acinetobacter Species ◽  
Carbapenem Resistant ◽  
Invasive Infections ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Active surveillance testing of carbapenem-resistant Enterobacteriaceae (AST-CRE) is recommended in high-risk settings, such as intensive care units (ICUs), to prevent CRE outbreaks or invasive infections. This study aimed to investigate the effects of AST-CRE by analyzing the prevalence and risk factors for acquiring CRE during the ICU care. Methods We conducted AST-CRE on rectal swabs of patients admitted to the ICU in the emergency room at a tertiary hospital in South Korea for 12.5 months. AST-CRE was performed upon admission and weekly thereafter. To assess the risk factors of acquiring AST-CRE during the admission period in adult patients, those colonized with CRE upon admission and aged &lt;18 years were excluded. AST-CRE was performed using Centers for Disease Control and Prevention methods. A polymerase chain reaction assay was performed to detect five carbapenemase genes (NDM, KPC, VIM, IMP, and OXA). Results A total of 810 patients were admitted during the study period. The acquisition rate and carbapenemase-producing CRE were 2.6% (21/810) and 42.9% (9/21), respectively. No invasive infection due to CRE was found. The most common species were Klebsiella pneumoniae (71.4%, 15/21), and eight KPC and one NDM genes were detected. In CRE-positive patients, in-hospital mortality and length of hospitalization were higher (P = 0.003) and longer (P &lt; 0.001), respectively. Multivariate analyses showed that male gender (adjusted odds ratio [aOR] 8.0; 95% confidence interval [CI] 1.7–36.8), previous hospitalization in the last year (aOR 5.1; 95% CI 1.6–16.4), co-colonization with multidrug-resistant Acinetobacter species (aOR 18.3; 95% CI, 4.2–79.2) and extended-spectrum β-lactamase-producing bacteria (aOR 3.4; 95% CI, 1.1–10.9), and length of ICU admission until CRE detection for ≥10 days (aOR 6.5; 95% CI 2.2–19.2) were independently associated with CRE acquisition. Conclusion To prevent CRE outbreak or invasive infections, patients admitted in the ICU should be screened using AST-CRE. Disclosures All authors: No reported disclosures.

scholarly journals 544. Clonal Spread of Two Sequence Types of Carbapenem-Resistant Acinetobacter baumannii Blood Isolates at a Tertiary Care Hospital in South Korea Over 2.5 Years

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S259-S260
Author(s):  
Seong Eun Kim ◽  
Su-Mi Choi ◽  
Yohan Yu ◽  
Sung un Shin ◽  
Tae hoon Oh ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Mortality Rates ◽  
The Other ◽  
Rank Test ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Log Rank Test ◽  
Clonal Spread

Abstract Background The dissemination of carbapenem-resistant Acinetobacter baumannii (CRAB) became an urgent public health concern. A specific sequence type (ST) of A. bauamannii has been reported to be associated with severity of disease or mortality. This study aimed to determine the genetic relatedness of CRAB blood isolates cultured from patients at a tertiary care hospital and to investigate clinical characteristics and outcome of CRAB bacteremia. Methods CRAB blood isolates were collected between June 2016 and December 2018, and their clinical data were obtained. Multi-locus sequence test (MLST) was performed using the Oxford scheme, and the STs were assigned using the MLST database. Results Of the 126 CRAB blood isolates, 123 isolates which could be typed by MLST all belonged to clonal complex (CC) 92. During the entire period, ST369 (42.3%) was the most dominant, followed by ST191 (32.5%), ST784 (13.8%) and ST451 (4.1%). ST369 was firstly introduced in August 2017. ST191 (61.4%) was the most abundant during June 2016 to July 2017, whereas ST369 (65.8%) replaced ST191 (16.5%) since August 2017. The time interval between intensive care unit admission and bacteremia was shorter in ST369 than ST191 in multivariate analysis (day, median (Q1, Q3), ST369 6 (3, 9.8), ST191 9 (6, 17), Odd Ratio 0.87 (95% CI 0.76–0.99) P = 0.048 logistic regression). According to the ST, the 7-day and 30-day mortality rates were as follows; 46% and 65% in ST191, 50% and 62% in ST369, and 10.7% and 46.4% in the other STs. Patients infected by ST191 or 369 had significant higher 7-day mortality rates (ST191/369, 48.3% vs. the other STs 10.7%, P = 0.001 by log-rank test) and 30-day mortality rates (ST191/369, 63.2% vs. the other STs, 46.4%, P = 0.045 by log-rank test). Conclusion This study demonstrates the clonal spread of two STs at a tertiary care hospital in South Korea over 2.5 years. After the introduction of ST369, it replaced ST 191 and widely disseminated within a hospital. Two predominant STs were associated with poor outcome. Continuous surveillance are necessary to monitor the dissemination of these strains. Disclosures All authors: No reported disclosures.

scholarly journals Characteristics Associated with Death in Patients with Carbapenem-Resistant Acinetobacter baumannii, United States, 2012–2017

2020 ◽  
Vol 41 (S1) ◽  
pp. s59-s60
Author(s):  
Hannah E. Reses ◽  
Kelly Hatfield ◽  
Jesse Jacob ◽  
Chris Bower ◽  
Elisabeth Vaeth ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acinetobacter Baumannii ◽  
Treatment Options ◽  
Care Facility ◽  
Severe Illness ◽  
Emerging Infections ◽  
Term Care ◽  
Icu Stay ◽  
Carbapenem Resistant ◽  
Sterile Site

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is an important cause of healthcare-associated infections with limited treatment options and high mortality. To describe risk factors for mortality, we evaluated characteristics associated with 30-day mortality in patients with CRAB identified through the Emerging Infections Program (EIP). Methods: From January 2012 through December 2017, 8 EIP sites (CO, GA, MD, MN, NM, NY, OR, TN) participated in active, laboratory-, and population-based surveillance for CRAB. An incident case was defined as patient’s first isolation in a 30-day period of A. baumannii complex from sterile sites or urine with resistance to ≥1 carbapenem (excluding ertapenem). Medical records were abstracted. Patients were matched to state vital records to assess mortality within 30 days of incident culture collection. We developed 2 multivariable logistic regression models (1 for sterile site cases and 1 for urine cases) to evaluate characteristics associated with 30-day mortality. Results: We identified 744 patients contributing 863 cases, of which 185 of 863 cases (21.4%) died within 30 days of culture, including 113 of 257 cases (44.0%) isolated from a sterile site and 72 of 606 cases (11.9%) isolated from urine. Among 628 hospitalized cases, death occurred in 159 cases (25.3%). Among hospitalized fatal cases, death occurred after hospital discharge in 27 of 57 urine cases (47.4%) and 21 of 102 cases from sterile sites (20.6%). Among sterile site cases, female sex, intensive care unit (ICU) stay after culture, location in a healthcare facility, including a long-term care facility (LTCF), 3 days before culture, and diagnosis of septic shock were associated with increased odds of death in the model (Fig. 1). In urine cases, age 40–54 or ≥75 years, ICU stay after culture, presence of an indwelling device other than a urinary catheter or central line (eg, endotracheal tube), location in a LTCF 3 days before culture, diagnosis of septic shock, and Charlson comorbidity score ≥3 were associated with increased odds of mortality (Fig. 2). Conclusion: Overall 30-day mortality was high among patients with CRAB, including patients with CRAB isolated from urine. A substantial fraction of mortality occurred after discharge, especially among patients with urine cases. Although there were some differences in characteristics associated with mortality in patients with CRAB isolated from sterile sites versus urine, LTCF exposure and severe illness were associated with mortality in both patient groups. CRAB was associated with major mortality in these patients with evidence of healthcare experience and complex illness. More work is needed to determine whether prevention of CRAB infections would improve outcomes.Funding: NoneDisclosures: None

scholarly journals 504. Epidemiology of End-stage Renal Disease (ESRD) Patients with Carbapenem-Resistant Enterobacteriaceae (CRE) Infections: Atlanta Metropolitan Area, 2012–2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S244-S245
Author(s):  
Jacqueline M Hurd ◽  
Chris W Bower ◽  
Jesse T Jacob
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Population Data ◽  
Arterial Disease ◽  
Population Based ◽  
Emerging Infections ◽  
Carbapenem Resistant ◽  
Stage Renal Disease ◽  
End Stage ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Patients with end-stage renal disease (ESRD) have higher risks for resistant organisms including carbapenem-resistant Enterobacteriaceae (CRE). To explore the effect of ESRD on CRE, we compared characteristics of CRE cases with and without ESRD in a population-based cohort. Methods The Georgia Emerging Infections Program has performed active laboratory- and population-based surveillance for CRE in metropolitan Atlanta (4.1 million in 2017) since 2012. CRE cases are defined by isolation from a sterile body site or urine of E. coli, K. pneumoniae, K. oxytoca, K. aerogenes, or E. cloacae. From 2012 to 2015, cultures were resistant to all third-generation cephalosporins tested and non-susceptible to ≥1 carbapenem (excluding ertapenem). After 2016, cultures were resistant to ≥1 carbapenems. Epidemiologic data including ESRD were collected via medical chart review. ESRD population data were obtained from the US Renal Data System. Georgia vital records data were used to determine 90-day mortality rates. Prevalence estimates were calculated. Comparisons used a χ 2 test. Results Of 1,511 CRE cases, 136 (9%) were on current chronic dialysis, 128 (94%) of which were on hemodialysis (HD) and 5 (4%) were on peritoneal dialysis. Among CRE cases with HD, 94 (73%) had a catheter and 30 (23%) had an arteriovenous fistula or graft. CRE cases with ESRD were more likely to be male (58% vs. 40%), black (76% vs. 38%), and have diabetes (67% vs. 38%), congestive heart failure (25% vs. 17%), or peripheral arterial disease (12% vs. 4%). CRE cases with ESRD had more hospitalizations within 30 days of the culture date (77% vs. 47%), ICU admissions prior to (29% vs. 7%) or after the culture date (43% vs. 14%) and discharges to LTCFs (35% vs. 15%) after hospitalization. CRE cases with ESRD and bacteremia were more likely to have been hospitalized >3 days before the culture compared with CRE cases with ESRD and positive cultures from other body sites (52% vs. 24%). The 90-day mortality rate per 100,000 population was higher among CRE cases with ESRD (100.9 cases) than without ESRD (1.0 cases). Conclusion Among a population-based cohort of patients with CRE infections, ESRD comprised ~10% but had markedly mortality, suggesting that future interventions should target ESRD. Disclosures All authors: No reported disclosures.

scholarly journals Deciphering Multidrug-Resistant Acinetobacter baumannii from a Pediatric Cancer Hospital in Egypt

mSphere ◽  
2021 ◽  
Author(s):  
Deena Jalal ◽  
Mariam G. Elzayat ◽  
Aya A. Diab ◽  
Hend E. El-Shqanqery ◽  
Omar Samir ◽  
...  
Keyword(s):  
Antimicrobial Agent ◽  
Acinetobacter Baumannii ◽  
Cancer Patients ◽  
Pediatric Cancer ◽  
Mortality Rates ◽  
Multidrug Resistant ◽  
Major Health ◽  
Content Type ◽  
Development Of Resistance ◽  
Carbapenem Resistant

Acinetobacter baumannii represents a major health threat, in particular among immunocompromised cancer patients. The rise in carbapenem-resistant A. baumannii , and the development of resistance to the last-resort antimicrobial agent colistin, complicates the management of A. baumannii outbreaks and increases mortality rates.

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