scholarly journals 1191. Prevalence and Microbiology of Carbapenem Resistance Among Six Gram-Negative Pathogens in Bloodstream Infections in US Hospitals, 2010–2015

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S360-S360 ◽  
Author(s):  
Thomas P Lodise ◽  
Roger Echols ◽  
Weiying Wang ◽  
Frank Corvino ◽  
Bin Cai
Keyword(s):  
Carbapenem Resistance ◽  
Bloodstream Infections ◽  
The United States ◽  
Research Support ◽  
The West ◽  
Healthcare Database ◽  
North Central ◽  
Gram Negative ◽  
E Coli ◽  
West North Central

Abstract Background Carbapenem resistance (CR) is a growing threat in hospitals in the United States and worldwide. We evaluated the prevalence and geographic distribution of CR among six most common Gram-negative (GN) bloodstream infection (BSI) pathogens in US hospitals. Methods We analyzed microbiology data in a cohort of adults (≥18 years) hospitalized in 181 US hospitals contributing microbiology data to the Premier Healthcare Database (October 2010–September 2015) with blood cultures positive for six most common GN pathogens (S. maltophilia assumed 100% CR). We report CR prevalence by pathogen, hospital ward (ICU vs. floor), and census region. Results Of the 43,095 GN BSIs included, 1,513 (3.5%) were caused by the six most common CR pathogens (Figure 1). CR was more frequently isolated from patients with an ICU stay (4.7%) vs. those without (2.7%). Nearly 75% (n = 1,100) of CR occurred in nonfermenters (S. maltophilia, P. aeruginosa, and A. baumannii). Among individual organisms, the prevalence of CR—outside of S. maltophilia—was highest among A. baumannii, 35.1%, and lowest among E. coli, 0.2% (Figure 2). Geographically, CR prevalence ranged from highest in the Mountain region (7.1%) to lowest in the West North Central (2.3%) (Figure 3). The maximum CR prevalence occurred in A. baumannii from the East North Central (55.7%), and the minimum in E. coli from the West North Central (0.05%) regions. Conclusion Among six most frequently isolated pathogens in BSI, the overall CR prevalence is 3.5%. The wide variations in prevalence based on organism, location in the hospital, and geography emphasize the clinical importance of knowing local pathogen and resistance patterns in order to optimize empiric treatment. Disclosures A. F. Shorr, Astellas: Consultant and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium. Cidara: Consultant, Consulting fee. Merck & Co.: Consultant and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium. T. P. Lodise Jr., Motif BioSciences: Board Member, Consulting fee.

scholarly journals 681. Epidemiology and Outcomes of Patients with Carbapenem-Resistant Bloodstream Infection in United States Hospitals, 2010–2015

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S245-S246
Author(s):  
Roger Echols ◽  
Frank Corvino ◽  
Bin Cai ◽  
Thomas P Lodise
Keyword(s):  
Cohort Analysis ◽  
Carbapenem Resistance ◽  
Bloodstream Infections ◽  
Study Patient ◽  
Research Support ◽  
Healthcare Database ◽  
Lengths Of Stay ◽  
Carbapenem Resistant ◽  
Retrospective Cohort Analysis ◽  
Comorbidity Index

Abstract Background Carbapenem resistance (CR) in patients with Gram-negative (GN) bloodstream infections (BSI) presents a mounting therapeutic challenge. To gain a better understanding of CR among patients in US hospitals, we explored their characteristics and outcomes. Methods We performed a retrospective cohort analysis of consecutive adult patients (age ≥18 years) with a positive blood culture for GN pathogens (11 most prevalent pathogens reported in ~53,811 study patient samples), hospitalized in one of 181 institutions contributing microbiology data to the Premier Healthcare Database (October 2010–September 2015). We compared patients with CR vs. carbapenem-susceptible (CS) BSIs based on their characteristics and outcomes. Primary outcome was mortality, and secondary outcomes included post-index culture hospital and ICU lengths of stay (LOS), and likelihood of being discharged home. Results Of the ~53,811 study patient samples, 46,381 patients had a GN BSI, with the prevalence of CR occurring at 3.5% (n = 1,602). Compared with patients with CS, those with CR were younger (mean/SD 60.4/17.1 vs. 67.4/16.4 years, P < 0.01), more likely to be male (52.8% vs. 45.9%, P < 0.01), black (22.7% vs. 17.7%, P < 0.01), and had Medicaid as a payor (18.1% vs. 10.9%, P < 0.01). The mean/SD Charlson Comorbidity Index was higher in CR than CS group (2.9/2.5 vs. 2.3/2.5, P < 0.01). Crude mortality was also higher (20.6% vs. 9.7%, P < 0.01) in the setting of CR than CS, as were unadjusted median (IQR) post-index culture hospital (9 [6, 15] vs. 7 [5, 10] days, P < 0.01), and ICU (5 [2, 11] vs. 3 [2, 6] days, P < 0.01) LOS. Patients with CR BSI were less likely to be discharged home than those with CS (32.7% vs. 53.8%, P < 0.001). Conclusion Patients with CR BSIs have lower likelihood of surviving hospitalization or being discharged home, and longer post-index culture hospital and ICU LOS, compared with those with CS BSIs. This highlights the need for better and more preventive and therapeutic strategies aimed at combating GN CR. Disclosures A. F. Shorr, Astellas: Consultant and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium Cidara: Consultant, Consulting fee. Merck & Co.: Consultant and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium. T. P. Lodise Jr., Motif BioSciences: Board Member, Consulting fee.

Associations of Antimicrobial-Resistant Gram-Negative Bloodstream Infections with Outcomes among Hospitalized Pediatric Patients in the United States

2021 ◽  
Author(s):  
Alicen Burns Spaulding ◽  
David Watson ◽  
Jill Dreyfus ◽  
Phillip Heaton ◽  
Christina Koutsari ◽  
...  
Keyword(s):  
United States ◽  
Retrospective Cohort ◽  
Pediatric Patients ◽  
Bloodstream Infections ◽  
The United States ◽  
Healthcare Database ◽  
Gram Negative ◽  
Drug Classes ◽  
Antibiotic Drug ◽  
The Impact

Abstract Objective The aim of this study was to assess the impact of pediatric antimicrobial-resistant gram-negative bloodstream infections (GNBSIs). Methods A retrospective cohort study (2009–2016) was conducted using the Premier Healthcare Database among pediatric admissions with GNBSIs at hospitals reporting microbiology data. Infections for neonates and nonneonates were classified as multidrug resistance (MDR), resistant to one or two antibiotic drug classes (1–2DR), or susceptible. Results Among 1,276 GNBSIs, 266 (20.8%) infections were 1–2DR and 23 (1.8%) MDR. Compared with susceptible GNBSIs, MDR nonneonates had higher mortality and higher costs, whereas 1–2DR neonates had longer stays and higher costs. Conclusions Antimicrobial-resistant GNBSIs were associated with worse outcomes among pediatric hospitalized patients.

scholarly journals 2851. Impact of Antimicrobial-Resistant Gram-Negative Bloodstream Infections on Outcomes Among Pediatric Hospitalizations in the United States, 2009–2016

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S73-S73
Author(s):  
Alicen B Spaulding ◽  
David Watson ◽  
Jill Dreyfus ◽  
Phillip Heaton ◽  
Anupam Kharbanda
Keyword(s):  
United States ◽  
Susceptibility Testing ◽  
Hospital Admissions ◽  
Bloodstream Infections ◽  
Healthcare Facility ◽  
The United States ◽  
Healthcare Database ◽  
Gram Negative ◽  
Patients Âgés ◽  
The Impact

Abstract Background Antimicrobial-resistant (AMR) Gram-negative bloodstream infections (GNBSIs) are more challenging to treat and may be associated with higher rates of morbidity and mortality. However, no recent studies have assessed the impact of pediatric AMR GNBSIs on outcomes. This study’s objective was to analyze the impact of AMR GNBSIs on mortality, length of stay (LOS), and costs among pediatric hospital admissions in the United States. Methods We conducted a retrospective cohort study of patients ages < 19 from the Premier Healthcare Database (2009–2016) limited to hospitals reporting ≥4 years of blood culture data and to encounters with susceptibility testing among the five most common laboratory-confirmed GNBSIs. AMR was defined per pathogen according to Centers for Disease Control and Prevention criteria. Outcomes mortality, LOS, and total patient encounter costs were compared between AMR and susceptible GNBSIs using Bayesian hierarchical regression modeling, which allowed us to analyze outcomes at the pathogen-level and to incorporate adjustment for confounding factors in order to produce risk-adjusted average differences or risk ratios (RR), and corresponding 95% credible intervals (CrI). Results Among 1,279 GNBSI encounters with susceptibility testing from 104 hospitals, 153 (12%) were AMR, but varied by pathogen. AMR GNBSI occurred more often among non-neonates (62% vs. 51%); non-neonates more often had hospital-acquired infections (27% vs. 13%) or were transferred from a healthcare facility (16% vs. 10%) vs. susceptible GNBSIs. The adjusted RR for mortality was 1.31 (95% CrI 0.62, 3.07) and adjusted average differences for LOS were 6.8 days (95% CrI: −0.3, 16.3) and for cost $23800 (95% CrI $400, $53900) comparing AMR to susceptible GNBSIs. Conclusion This study analyzed the impact of AMR GNBSIs, which were rare, on pediatric patient outcomes using laboratory-confirmed GNBSIs with susceptibility results and advanced statistical methods, finding the greatest impact of pediatric AMR on costs. Knowing the impact of AMR GNBSIs can help improve management of these serious infections, increase clinician and patient awareness of the issue, and further strengthen evidence for justifying pediatric antimicrobial stewardship. Disclosures All Authors: No reported Disclosures.

scholarly journals 1004. Frequency of Occurrence and Antimicrobial Susceptibility of Bacteria Isolated From Patients Hospitalized With Bloodstream Infections in United States Medical Centers (2015–2017)

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S299-S299
Author(s):  
Helio S Sader ◽  
Robert K Flamm ◽  
Michael A Pfaller ◽  
Mariana Castanheira
Keyword(s):  
United States ◽  
Antimicrobial Susceptibility ◽  
Bloodstream Infections ◽  
The United States ◽  
Research Support ◽  
Coagulase Negative Staphylococci ◽  
E Coli ◽  
Medical Centers ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Bloodstream infections (BSIs) cause significant morbidity and mortality. We evaluated the frequency and antimicrobial susceptibility of bacteria causing BSIs in the United States. Methods A total of 9,210 bacterial isolates were consecutively collected (1/patient) from 33 US medical centers in 2015–2017 and tested for susceptibility by reference broth microdilution methods in a central laboratory (JMI Laboratories) as part of the International Network for Optimal Resistance Monitoring (INFORM) program. Whole-genome sequencing was performed on carbapenem-resistant Enterobacteriaceae (CRE). Results The most common organisms were S. aureus (SA; 24.3%), E. coli (EC; 20.8%), K. pneumoniae (KPN; 9.1%), coagulase-negative staphylococci (7.3%), E. faecalis (5.5%), P. aeruginosa (PSA; 4.7%), and β-hemolytic streptococci (4.7%). Overall, 50.0% of isolates were Gram-negative bacilli (GNB) and 41.4% were Enterobacteriaceae (ENT). All SA were susceptible (S) to dalbavancin (MIC90, 0.03 μg/mL), linezolid, tigecycline (TGC), and vancomycin; &gt;99.9% S to daptomycin, 97.6% S to ceftaroline, and 57.8% S to oxacillin. The most active agents against ENT were CAZ-AVI (99.9% S; table), amikacin (AMK; 99.7% S), and the carbapenems meropenem (MEM) and doripenem (99.1% S). Ceftolozane-tazobactam (C-T; tested in 2017 only) was active against 96.9% of ENT. Ceftriaxone (CRO)-S rates were 83.0% and 86.5% among EC and KPN, respectively. CRO-non-S KPN exhibited low S rates to most agents, except CAZ-AVI (99.1% S), TGC (93.6%), AMK (93.8%), and colistin (COL; 93.4%). Among 28 CRE isolates (0.7% of ENT), 21 produced a KPC-like, 2 an NMD-like, and 1 a KPC-17 and an NDM-1. COL (100.0% S), C-T (98.7%S), CAZ-AVI (98.2% S), AMK (97.9% S), and tobramycin (95.6% S) were very active against PSA. CAZ-AVI and C-T remained active against most PSA isolates non-S to MEM (93.0 and 95.0% S, respectively) and/or piperacillin–tazobactam (P-T; 88.9 and 91.3% S) and/or CAZ (86.9 and 88.2% S). Conclusion GNB represented 50.0% of bacteria isolated from patients with BSIs and the most active agents against these organisms were CAZ-AVI and AMK. Various agents exhibited excellent overall coverage against Gram-positives, including dalbavancin, daptomycin, linezolid, and TGC. Disclosures H. S. Sader, Allergan: Research Contractor, Research support. R. K. Flamm, Allergan: Research Contractor, Research support. M. A. Pfaller, Allergan: Research Contractor, Research support. M. Castanheira, Allergan: Research Contractor, Research support.

PRE-BONNEVILLE LAKES IN CACHE VALLEY AND EXCAVATION OF CUTLER NARROWS ACROSS THE CACHE BUTTE DIVIDE IN THE WEST, NORTH-CENTRAL UTAH AND SOUTHEASTERN IDAHO

2020 ◽  
Author(s):  
Robert Q. Oaks ◽  
◽  
Susanne U. Janecke ◽  
Tammy M. Rittenour ◽  
Thad L. Erickson ◽  
...  
Keyword(s):  
The West ◽  
North Central ◽  
Cache Valley ◽  
West North Central

scholarly journals 1375. In vitro Activity of Cefiderocol and Comparator Agents against Gram-Negative Isolates from Cancer Patients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S421-S422 ◽  
Author(s):  
Kenneth V I Rolston ◽  
Bahgat Gerges ◽  
Issam Raad ◽  
Samuel L Aitken ◽  
Ruth Reitzel ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Active Agent ◽  
Vitro Activity ◽  
Significant Activity ◽  
In Vitro Activity ◽  
Research Support ◽  
Gram Negative ◽  
E Coli ◽  
Research Grant

Abstract Background Gram-negative bacilli (GNB) are now the predominant cause of bacterial infection in cancer patients (CP). Many GNB are problematic because they have become resistant to commonly used antibiotics. Cefiderocol (CFDC), a novel siderophore cephalosporin, is active against a wide spectrum of GNB. We evaluated its in vitro activity and that of eleven comparator agents against GNB isolated from CP. Methods A total of 341 recent GNB blood isolates from CP were tested using CLSI approved methods for MIC determination by broth microdilution. Comparator agents were amikacin (A), aztreonam (AZ), ceftazidime (CZ), ceftazidime/avibactam (CAV), cefepime (CEF), ciprofloxacin (CIP), colistin (CL), meropenem (MR), ceftolozane/tazobactam (C/T), tigecycline (TG), and trimethoprim/sulfamethoxazole (T/S). Results CFDC MIC90s as mg/L were: S. maltophilia [50 isolates] 0.25, E. coli (ESBL−) [50 isolates] 0.5, E. coli (ESBL+) [51 isolates] 2.0, K. pneumoniae (ESBL− and +) [60 isolates] 0.5; K. pneumoniae (CRE) [22 isolates] 2.0; P. aeruginosa (MDR) [32 isolates] 1.0; E. cloacae [27 isolates] 4.0; Achromobacter spp. [15 isolates] 0.12. CFDC inhibited P. agglomerans, Burkholderia spp., Sphingomonas spp., Ochrobactrum spp. at ≤1 mg/L [23 total isolates] and Elizabethkingia spp. and R. radiobacter at ≤8 mg/L [11 total isolates]. Among comparator agents, only T/S had consistent activity against S. maltophilia. For E. coli (ESBL− and +) MR, TG, CAV, CL were most active. For K. pneumoniae (ESBL–and +) MR, CAV were most active. For K. pneumoniae (CRE) and P. aeruginosa (MDR), none of the comparators had significant activity. For E. cloacae, MR, A, CAV, TG were most active. Among the uncommon organisms, MR and TG had the greatest activity. Conclusion Although susceptibility breakpoints have yet to be determined, CFDC has significant activity (≤4 mg/L) against most problematic Gram-negative organisms causing infections in CP based on available pharmacokinetic/pharmacodynamic data. In particular, its activity against S. maltophilia was superior to the comparators. Also, it was the most active agent against P. aeruginosa (MDR) and K. pneumoniae (CRE). Based on our results, CFDC warrants clinical evaluation for the treatment of blood stream infections caused by GNB in CP. Disclosures K. V. I. Rolston, Merck: Investigator, Research grant; JMI Laboratories: Investigator, Research grant; Shionogi (Japan): Investigator, Research grant. B. Gerges, Shionogi: Collaborator, Research support. S. L. Aitken, Shionogi: Scientific Advisor, Consulting fee; Merck: Scientific Advisor, Consulting fee; Medicines Co: Scientific Advisor, Consulting fee; Achaogen: Scientific Advisor, Consulting fee; Zavante: Scientific Advisor, Consulting fee; R. Prince, Shionogi: Investigator, Research support. Merck: Investigator, Research support.

Abstract MP75: Geographic Variation in Stroke Rates and Oral Anticoagulation Use among Medicare Beneficiaries with Atrial Fibrillation

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Inmaculada Hernandez ◽  
Samir Saba ◽  
Yuting Zhang
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Geographic Variation ◽  
Newly Diagnosed ◽  
Medicare Beneficiaries ◽  
The West ◽  
North Central ◽  
Census Division ◽  
Adjusted Rate ◽  
West North Central

Background: Recent studies have shown strong geographic variation in oral anticoagulation (OAC) use in atrial fibrillation (AF); however, it remains unknown how this contributes to the geographic variation in ischemic stroke observed across the US. The objective of the present study was to evaluate the relationship between the geographic variation in the initiation of OAC and the incidence of ischemic stroke in a cohort of Medicare beneficiaries newly diagnosed with AF. Methods: Using 2013-2014 claims data from a 5% random sample of Medicare beneficiaries, we identified patients newly diagnosed with AF in 2013-2014 and categorized them according to their initiation of OAC. Our sample included 21,226 OAC initiators and 20,068 patients who did not initiate OAC therapy. We assigned each patient to one of the 9 US Census Divisions using the zip code, and collected their medical claims with a diagnosis of ischemic stroke. We constructed logistic regression models to estimate the average adjusted probability of OAC initiation and Poisson models to estimate the average adjusted rate of ischemic stroke, in each Census Division. Both estimates were adjusted for demographics, eligibility for Medicaid coverage and for low-income subsidy, enrollment in a Medicare Advantage Part D plan, and a comprehensive list of clinical characteristics. We computed the correlation between the average adjusted probability of OAC initiation and the average adjusted rate of ischemic stroke at the Census Division level. Results: The probability of OAC initiation was lowest in the West South Central (0.47) and highest in the West North Central (0.54) and New England (0.54). The average adjusted rate of ischemic stroke was lowest in the West North Central (0.09) and highest in the South Atlantic (0.14) and South West Central (0.14). The average adjusted probability of OAC initiation at the Census Division level and the average adjusted rate of ischemic stroke were inversely correlated, with R=-0.576, p-value=0.10. This suggests that variation in OAC initiation likely explains at least a third of geographic variation in ischemic stroke [R 2 =(-0.576) 2 =0.332]. Conclusions: Our results suggest that geographic variations in OAC initiation within the U.S. explain, in part, variations in the incidence of ischemic stroke among AF patients. Further mechanistic research using advanced causal mediation models is warranted.

PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK

PEDIATRICS ◽  
1948 ◽  
Vol 2 (1) ◽  
pp. 138-140
Keyword(s):  
Public Health ◽  
South Carolina ◽  
New England ◽  
The West ◽  
Central Section ◽  
North Central ◽  
South Central ◽  
High Incidence ◽  
Health Nursing ◽  
West North Central

THE accompanying table summarizes the incidence of nine important communicable diseases, based on weekly telegraphic reports from State health departments. The reports from each State for each week are published in PUBLIC HEALTH REPORTS under the section "Incidence of Disease." [See Table in Source Pdf]. Diseases Above Median Incidence Measles—The number of cases of measles rose from 102,680 during the preceding 4 weeks to 114,983 during the 4 weeks ended May 22. The incidence was 3.4 times the number of cases reported for the corresponding period in 1947, which was, however, a comparatively low measles year, but it was only about 10 percent above the 1943-47 median. In the New England and East South Central sections the incidence was below the normal expectancy and in the South Atlantic section the number of cases was only slightly higher than the median for the preceding 5 years, but in the other 6 sections the increases over the median expectancy ranged from 1.1 times the median in the West North Central section to 3.4 times the median in the West South Central section. Poliomyelitis.— The number of cases of poliomyelitis rose from 126 during the preceding 4-week period to 440 during the current 4 weeks. The incidence was 3.5 times that reported for these weeks in 1947, which number (126 cases) also represents the 1943-47 median. An increase of this disease is expected at this season of the year, but the current number of cases represents a larger increase at this time than has normally occurred in preceding years. While each section of the country except New England contributed to the relatively high incidence, the greatest excesses over the 5-year medians were reported from the West North Central and West South Central sections. Of the total cases Texas reported 179, California 62, South Carolina 46, New Jersey 16, Iowa 14, Florida 12, Alabama 11, and Illinois, South Dakota, and Louisiana 10 each; 85 percent of the reported cases occurred in those 10 states which represent every section of the country except the New England and Mountain sections. Since the beginning of the year there have been 947 cases of poliomyelitis reported as compared with 894 and 810 for the corresponding period in 1947 and 1946, respectively.

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