scholarly journals 1071. Impact of Standard vs. Prolonged Courses of Antibiotics for the Treatment of Uncomplicated Staphylococcus aureus Bacteremia (SAB) in Patients With Hematologic Malignancies

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S320-S321 ◽  
Author(s):  
Edna Cheung ◽  
Matt G McKenzie ◽  
Lydia Benitez Colon ◽  
Keith S Kaye ◽  
Lindsay Petty ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Clinical Cure ◽  
Hematologic Malignancies ◽  
Joint Involvement ◽  
Standard Group ◽  
Duration Of Treatment ◽  
Antibiotic Duration ◽  
The Impact ◽  
Refractory Malignancy

Abstract Background The optimal treatment duration for uncomplicated SAB (U-SAB) is unknown in patients with hematologic malignancies. The goal of this study was to evaluate the impact of antibiotic duration on outcomes in patients with hematologic malignancies and U-SAB. Methods This was a multicenter, retrospective cohort study of adult patients with hematologic malignancies and U-SAB treated with standard (2 weeks) or prolonged (>2 weeks) antibiotic therapy. U-SAB was defined as defervescence and culture clearance within 96 hours of index culture and the absence of: endocarditis, implanted prostheses, metastatic sites of infection, and bone/joint involvement. Patients with SAB therapy <10 days and those with inadequate source control were excluded. The primary outcome was a composite global clinical cure: absence of relapse SAB, absence of SAB progression, and survival at 60 days following index SAB. Results Of 89 included patients, 51% received a standard antibiotic duration for U-SAB. The median age of the entire cohort was 56 and majority was male (60%). Neutropenia was present at index culture in 53% of patients, and acute leukemia (48%) and lymphoma (26%) were the most common underlying malignancies. Other baseline characteristics were similar between the two groups except more patients in the standard duration group had relapsed/refractory malignancy (51% vs. 25%, P = 0.016), central-line source (71% vs. 48%, P = 0.032), and antibiotic prophylaxis prior to index SAB (42% vs. 18%, P = 0.021). Median duration of treatment in the standard group was 15 days vs. 28 days in the prolonged duration group. No differences in global clinical cure and other clinical outcomes were seen between groups (Figure 1). On multivariable logistic regression analysis, only relapsed/refractory malignancy was identified as an independent predictor of global clinical failure (odds ratio, OR, 9.43; 95% confidence interval, CI, 1.17–76.9; P = 0.035). Duration of treatment was not associated with global clinical cure (OR, 2.92; 95% CI, 0.51–16.7; P = 0.23). Conclusion No differences in clinical outcomes were seen in patients with active hematologic malignancies who received 2 weeks vs. >2 weeks of antibiotic therapy for the treatment of U-SAB, although confirmation of our findings in a larger study is warranted. Disclosures All authors: No reported disclosures.

scholarly journals 452. Antibiotic Duration, but Not Size, Impacts Clinical Cure of Limited Skin and Soft-Tissue Infection After Incision and Drainage

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S222-S223
Author(s):  
Jason G Lake ◽  
Stephanie Fritz
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Clinical Cure ◽  
Day Treatment ◽  
Treatment Protocol ◽  
Chi Square ◽  
Incision And Drainage ◽  
Exact Test ◽  
Days Of Therapy ◽  
Antibiotic Duration

Abstract Background Incision and drainage (I&D) is the most common treatment for skin abscesses. A recent randomized clinical trial (RCT) of outpatients with limited (≤5 cm) skin abscesses demonstrated antibiotic therapy with clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) was superior to I&D alone. We performed a subgroup analysis to measure the effect of antibiotic duration and abscess size on clinical cure at 7–10 days after antibiotic completion. Methods Participants with complete data regarding adherence to the 10-day treatment were included. Demographic and baseline clinical features were compared using t-test, Pearson’s chi-square or Fisher’s exact test, or a non-parametric equivalent where appropriate. Largest abscess dimension (cm) was dichotomized by median size. The effect of antibiotic duration, abscess size (≤ median vs. >median) and covariates on clinical cure were measured using logistic regression. Breslow-Day Test for Homogeneity was used to assess the interaction between treatment and abscess size. Results Of 786 participants in the intention-to-treat analysis, complete adherence data were available for 680 (87%) participants. Of these, 463 (68%) received either antibiotic: 421 (91%) completed 10 days of therapy, 29 (6.3%) ≤7 days and 20 (4.3%) ≤5 days. Only antibiotic treatment duration was associated with clinical cure (table). Odds of clinical cure were 1.7 (95% CI: 1.5, 2.0) times higher for each additional day of treatment. Median abscess size was 2.5 cm (range: 0.2–5); 364 participants had abscesses ≤ median vs. 316 >median. Assessed continuously, abscess size was not associated with cure within antibiotic groups (table) or between placebo and treatment groups (OR 0.94, 95% CI: 0.58–1.5). Stratifying on size, no significant interaction was observed with antibiotic treatment (Breslow-Day P = 0.13). Conclusion Adherence to the treatment protocol was high. These data suggest that longer courses of antibiotic therapy in conjunction with I&D are associated with successful treatment of limited skin abscesses. Size was not associated with clinical cure. Prospective RCTs to determine the optimal length of treatment are needed. Disclosures All authors: No reported disclosures.

scholarly journals 82. Assessment of Clinical Outcomes and Antibiotic Prescribing Patterns Following Implementation of the GenMark ePlex® Blood Culture Identification Panel for Gram-positive Bloodstream Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S157-S157
Author(s):  
Megan Wein ◽  
Shawn Binkley ◽  
Vasilios Athans ◽  
Stephen Saw ◽  
Tiffany Lee ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Gram Stain ◽  
Gram Positive ◽  
Significant Difference ◽  
Culture Identification ◽  
The Impact

Abstract Background Rapid diagnostic testing (RDT) of bloodstream pathogens provides key information sooner than conventional identification and susceptibility testing. The GenMark ePlex® blood culture identification gram-positive (BCID-GP) panel is a molecular-based multiplex platform, with 20 Gram-positive target pathogens and 4 bacterial resistance genes that can be detected within 1.5 hours of blood culture positivity. Published studies have evaluated the accuracy of the ePlex® BCID-GP panel compared to traditional identification methods; however, studies evaluating the impact of this panel on clinical outcomes and prescribing patterns are lacking. Methods This multi-center, quasi-experimental study evaluated clinical outcomes and prescribing patterns before (December 2018 – June 2019) and after (August 2019 – January 2020) implementation of the ePlex® BCID-GP panel in June 2019. Hospitalized, adult patients with growth of Enterococcus faecalis, Enterococcus faecium, or Staphylococcus aureus from blood cultures were included. The primary endpoint was time to targeted antibiotic therapy, defined as time from positive Gram-stain to antibiotic adjustment for the infecting pathogen. Results A total of 200 patients, 100 in each group, were included. Time to targeted therapy was 47.9 hours in the pre-group versus 24.8 hours in the post-group (p< 0.0001). Time from Gram-stain to organism identification was 23.03 hours (pre) versus 2.56 hours (post), p< 0.0001. There was no statistically significant difference in time from Gram-stain to susceptibility results, hospital length of stay (LOS), or all-cause 30-day mortality. Conclusion Implementation of the GenMark ePlex® BCID-GP panel reduced time to targeted antibiotic therapy by nearly 24 hours. Clinical outcomes including hospital LOS and all-cause 30-day mortality did not show a statistical difference, although analysis of a larger sample size is necessary to appropriately assess these outcomes. This study represents the effect of RDT implementation alone, in the absence of stewardship intervention, on antibiotic prescribing patterns. These findings will inform the design of a dedicated RDT antimicrobial stewardship intervention at our institution, while also being generalizable to other institutions with RDT capabilities. Disclosures All Authors: No reported disclosures

scholarly journals A Multicenter Stewardship Initiative to Decrease Excessive Duration of Antibiotic Therapy for the Treatment of Community-Acquired Pneumonia (CAP)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S63-S64
Author(s):  
Farnaz Foolad ◽  
Angela Huang ◽  
Cynthia Nguyen ◽  
Lindsay Colyer ◽  
Megan Lim ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Total Duration ◽  
Audit And Feedback ◽  
Patient Specific ◽  
Control Group ◽  
Duration Of Therapy ◽  
The Impact ◽  
Research Grant

Abstract Background Hospitals have implemented multifaceted approaches to quickly identify CAP, start timely therapy, and reduce hospital readmission, yet there has been minimal focus on providing appropriate duration of therapy. The IDSA CAP guidelines recommend 5 days of antibiotic therapy for patients that are clinically stable and quickly defervesce. However, previous publications suggest duration of therapy for CAP may be unnecessarily prolonged. Methods The objective of this multicenter, quasi-experimental study of hospitalized patients with CAP was to assess the impact of a prospective 6-month stewardship intervention on total duration of antibiotic therapy and associated clinical outcomes. All centers updated institutional CAP guidelines to promote IDSA-concordant durations of therapy and provided education to pharmacists and prescribers. Daily patient-specific prospective audit and feedback was provided by infectious diseases stewardship pharmacists to optimize compliance with guideline recommendations. Results A total of 600 patients were included (307 in the historic control group and 293 in the stewardship intervention group). The stewardship intervention led to significantly increased rates of compliance with IDSA duration of therapy recommendations (5.6% vs. 41.4%, P< < 0.01) and significantly reduced the duration of therapy for CAP (9 vs. 6 days, P < 0.01). Inappropriate days of antibiotic therapy was reduced in the intervention group (4 vs. 1.6 days, P < 0.01), and total avoidance of 720 excessive days of antibiotic therapy. Clinical outcomes, including mortality, length of hospitalization, readmission to hospital with pneumonia, presentation to the ER/clinic with pneumonia within 30 days of discharge, and incidence of C. difficilecolitis, were not different between groups. Conclusion This multicenter evaluation of a prospective stewardship intervention in hospitalized CAP patients reduced the total duration of antibiotic therapy and increased compliance with guideline-concordant duration of therapy without adversely affecting patient outcomes. This project was funded through a competitive stewardship grant provided by Merck & Co. Disclosures A. Huang, Merck: Grant Investigator, Research grant; C. Nguyen, Merck: Grant Investigator, Research grant; J. Grieger, Merck: Grant Investigator, Research grant; S. Revolinski, Merck: Grant Investigator, Research grant; J. Li, Merck: Grant Investigator, Research grant; M. Mack, Merck: Grant Investigator, Research grant; J. N. Wainaina, Merck: Grant Investigator, Research grant; G. Eschenauer, Merck: Grant Investigator, Research grant; T. Patel, Merck: Grant Investigator, Research grant; V. Marshall, Merck: Grant Investigator, Research grant; J. Nagel, Merck: Grant Investigator, Research grant

scholarly journals 52. Development and Implementation of a Short Duration of Antibiotic Therapy Algorithm for Uncomplicated Gram-Negative Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S48-S48
Author(s):  
Esther Y Bae ◽  
Fidelia Bernice ◽  
Kathryn Dzintars ◽  
Sara E Cosgrove ◽  
Pranita D Tamma ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Median Duration ◽  
Intervention Period ◽  
Therapy Algorithm ◽  
Gram Negative ◽  
Duration Of Therapy ◽  
Number Of Patients ◽  
Gram Negative Bacteremia ◽  
The Impact

Abstract Background Recent literature suggests no difference in clinical outcomes between short (7 days) and prolonged course (14 days) antibiotic therapy for the treatment of uncomplicated Gram-negative bacteremia (GNB). Methods The objectives of the study were to develop and implement a treatment algorithm that identifies patients who are eligible for 7-day therapy for uncomplicated GNB and evaluate its impact on patient outcomes at The Johns Hopkins Hospital (JHH) in Baltimore. The algorithm was developed and implemented at JHH on 11/11/2019. From 11/11/2019 to 3/31/2020, the Infectious Diseases (ID) Pharmacy Resident and ID pharmacists reviewed cases of GNB on weekdays and contacted teams to provide algorithm-compliant treatment recommendations. To quantify the impact of the intervention on clinical outcomes, data from the same time period during the previous year (baseline) were collected and compared to those collected during the intervention. The primary outcome was duration of antibiotic therapy for GNB. Secondary outcomes included: duration of intravenous (IV) antibiotics, length of hospital stay (LOS), and recurrent bacteremia. Results A total of 345 patients with GNB were identified (142 baseline; 203 intervention) of which 59 and 55 patients met criteria for 7-day therapy, respectively. The Pitt bacteremia score (median 1), bacteremia source [urinary (43%), abdominal (23%)], and organisms [E. coli (48%) and Klebsiella spp. (33%)] were similar between the periods. More patients in the intervention period were treated for ≤8 days (60.0% vs. 37.3%; p=0.015), and the median duration of therapy was 2 days shorter (8 vs. 10 days; p=0.04). Median duration of IV antibiotic therapy (4 vs. 7 days; p=0.004) and median LOS (4 vs. 7 days; p=0.029) were also shorter in the intervention period. There were no differences in the rate of 30-day recurrent bacteremia between the periods (3.4% baseline vs. 1.8% intervention; p=0.60). Conclusion Our pharmacist-led intervention successfully shortened the duration of therapy, increased conversion from IV to PO therapy, and reduced LOS, without negatively impacting the number of patients with recurrent GNB. Disclosures All Authors: No reported disclosures

scholarly journals 1575. Predictors of Negative Clinical Outcomes among Patients treated with Meropenem-Vaborbactam for Serious Gram-Negative Bacterial Infections: Impact of Delayed Appropriate Antibiotic Selection

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S786-S786
Author(s):  
Sara Alosaimy ◽  
Abdalhamid M Lagnf ◽  
Sarah Jorgensen ◽  
Travis J Carlson ◽  
Jinhee Jo ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Bacterial Infections ◽  
The United States ◽  
Research Support ◽  
Gram Negative ◽  
Appropriate Therapy ◽  
Tract Infections ◽  
The Impact

Abstract Background Numerous number of studies have found a positive correlation between delayed appropriate antibiotic therapy and negative clinical outcomes (NCO) in Gram-negative bacterial infections (GNBI). The combination of meropenem with vaborbactam (MVB) received Food and Drug Administration approval for the treatment of complicated urinary tract infections and acute pyelonephritis caused by susceptible organisms in August 2017. We sought to determine the impact of delayed appropriate therapy with MVB on NCO among patients with GNBI. Methods Multi-center, retrospective cohort study from October 2017 to March 2020. We included adult patients treated with MVB for >72 hours. We excluded patients who received alternative appropriate antibiotics for GNB prior to MVB and patients with unknown dates for index culture. NCO were defined as 30-day mortality and/or microbiological recurrence. All outcomes were measured from MVB start date. Classification and regression tree analysis (CART) was used to identify the time breakpoint (BP) that delineates the risk of NCO. Multivariable logistic regression analysis (MLR) was used to examine the independent association between the CART-derived-BP and NCO. Variables were retained in the model if P< 0.2 and removed in a backward stepwise approach. Results A total of 86 patients were included from 13 institutions in the United States: median(IQR) age 55 (37-67) years, 67% male, and 48% Caucasian. Median(IQR) APACHE II and Charlson Comorbidity index scores were 18(11-26) and 4(2-6), respectively. Common sources of infection were respiratory (37%) and intra-abdominal (21%). The most common pathogens were carbapenem-resistant Enterobacterales (83%). CART-derived BP between early and delayed treatment was 48 hours, where NCO was increased (36% vs.7%; P=0.04). Delayed MVB initiation was independently associated with NCO in the MLR (aOR=7.4, P=0.02). Results of Regression Analysis of Variables Associated With Negative Clinical Outcomes and Delayed Appropriate Therapy with Meropenem-vaborbactam Conclusion Our results suggest that delaying appropriate antibiotic therapy with MVB for >48 hours significantly increases the risk of NCO in patients with GNBI. Clinicians must ensure timely administration of MVB to assure best outcomes in patients with GNBI. Disclosures Kevin W. Garey, PharMD, MS, FASHP, Merck & Co. (Grant/Research Support, Scientific Research Study Investigator) Michael J. Rybak, PharmD, MPH, PhD, Paratek (Grant/Research Support)

scholarly journals Reducing the use of empiric antibiotic therapy in COVID-19 on hospital admission

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Natasha N. Pettit ◽  
Cynthia T. Nguyen ◽  
Alison K. Lew ◽  
Palak H. Bhagat ◽  
Allison Nelson ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Empiric Antibiotic Therapy ◽  
Antibiotic Prescribing ◽  
Post Intervention ◽  
Empiric Antibiotics ◽  
Empiric Antibiotic ◽  
The Impact ◽  
Post Intervention Group

Abstract Background Empiric antibiotics for community acquired bacterial pneumonia (CABP) are often prescribed to patients with COVID-19, despite a low reported incidence of co-infections. Stewardship interventions targeted at facilitating appropriate antibiotic prescribing for CABP among COVID-19 patients are needed. We developed a guideline for antibiotic initiation and discontinuation for CABP in COVID-19 patients. The purpose of this study was to assess the impact of this intervention on the duration of empiric CABP antibiotic therapy among patients with COVID-19. Methods This was a single-center, retrospective, quasi-experimental study of adult patients admitted between 3/1/2020 to 4/25/2020 with COVID-19 pneumonia, who were initiated on empiric CABP antibiotics. Patients were excluded if they were initiated on antibiotics > 48 h following admission or if another source of infection was identified. The primary outcome was the duration of antibiotic therapy (DOT) prior to the guideline (March 1 to March27, 2020) and after guideline implementation (March 28 to April 25, 2020). We also evaluated the clinical outcomes (mortality, readmissions, length of stay) among those initiated on empiric CABP antibiotics. Results A total of 506 patients with COVID-19 were evaluated, 102 pre-intervention and 404 post-intervention. Prior to the intervention, 74.5% (n = 76) of patients with COVID-19 received empiric antibiotics compared to only 42% of patients post-intervention (n = 170), p < 0.001. The median DOT in the post-intervention group was 1.3 days shorter (p < 0.001) than the pre-intervention group, and antibiotics directed at atypical bacteria DOT was reduced by 2.8 days (p < 0.001). More patients in the post-intervention group were initiated on antibiotics based on criteria consistent with our guideline (68% versus 87%, p = 0.001). There were no differences between groups in terms of clinical outcomes. Conclusion Following the implementation of a guideline outlining recommendations for initiating and discontinuing antibiotics for CABP among COVID-19 inpatients, we observed a reduction in antibiotic prescribing and DOT. The guideline also resulted in a significant increase in the rate of guideline-congruent empiric antibiotic initiation.

scholarly journals 119. Procalcitonin to Guide Antibiotic Therapy for Respiratory Infection: A Systematic Review of Systematic Reviews

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S73-S73
Author(s):  
Joshua A York ◽  
Maithili Varadarajan ◽  
Joseph R Yates ◽  
Gavin Barlow
Keyword(s):  
Antimicrobial Resistance ◽  
Antibiotic Therapy ◽  
Respiratory Infection ◽  
Systematic Reviews ◽  
Data Extraction ◽  
Control Group ◽  
Consistent Finding ◽  
Antibiotic Duration ◽  
Course Length ◽  
The Impact

Abstract Background Antimicrobial resistance is an international calamity; closely linked to antibiotic use. Safely reducing antibiotic course length and overall use are imperative. Procalcitonin (PCT) is a biomarker expressed in serum in response to bacterial infection. Systematic reviews (SRs) evaluating PCT as an adjunct to guide antibiotic therapy have been performed but its use remains contentious. The aim of this SR of SRs was to evaluate the extent to which PCT impacts the likelihood of antibiotic initiation and antibiotic duration in cases of respiratory infection. Methods A systematic search of databases using an a priori strategy was conducted. SRs which reported an outcome related to antibiotic initiation and/or duration in the context of respiratory infection were included. Data extraction was performed by the first author and checked independently by a second author. The quality of SRs was assessed by two authors independently using ROBIS criteria. Disagreements were resolved by consensus with a third author. Results are presented narratively and in tabular format (Table 1 and Table 2). Results 13 SRs were included (see PRISMA diagram). The number of respiratory patients included in these SRs ranged from 308 to 6708 (median = 3457). There was a consistent finding of a statistically significant reduction in antibiotic initiation in the PCT study group compared to the control group (Table 1). SRs that meta-analysed antibiotic duration (n = 9) as a difference in days showed a median reduction of 2.15 days (reduction range 0.80 to 3.83 days) with PCT use. PRISMA Diagram Table 1: Summary of odds ratios/ risk ratios in antibiotic initiation with the use of PCT Conclusion PCT use leads to a reduction in antibiotic initiation for respiratory diseases. It also results in a decrease in antibiotic duration, but this finding was not consistently statistically significant. There are no data presented in the SRs about the impact of this on antimicrobial resistance. Disclosures All Authors: No reported disclosures

scholarly journals Reducing the use of empiric antibiotic therapy in patients on admission to the hospital with COVID-19

2020 ◽  
Author(s):  
Natasha N. Pettit ◽  
Cynthia T. Nguyen ◽  
Alison Lew ◽  
Palak Bhagat ◽  
Allison Nelson ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Empiric Antibiotic Therapy ◽  
Antibiotic Prescribing ◽  
Post Intervention ◽  
Empiric Antibiotics ◽  
Empiric Antibiotic ◽  
The Impact ◽  
Post Intervention Group

Abstract Background: Empiric antibiotics for community acquired bacterial pneumonia (CABP) are often prescribed to patients with COVID-19, despite a low reported incidence of co-infections. Stewardship interventions targeted at facilitating appropriate antibiotic prescribing for CABP among COVID-19 patients are needed. We developed a guideline for antibiotic initiation and discontinuation for CABP in COVID-19 patients. The purpose of this study was to assess the impact of this intervention on the duration of empiric CABP antibiotic therapy among patients with COVID-19. Methods: This was a single-center, retrospective, quasi-experimental study of adult patients admitted between 3/1/2020 to 4/25/2020 with COVID-19 pneumonia, who were initiated on empiric CABP antibiotics. Patients were excluded if they were initiated on antibiotics >48hours following admission or if another infection was identified. The primary outcome was the duration of antibiotic therapy (DOT) prior to the guideline (March 1 to March27, 2020) and after guideline implementation (March 28 to April 25, 2020). We also evaluated the clinical outcomes (mortality, readmissions, length of stay) among those initiated on empiric CABP antibiotics. Results: A total of 506 patients with COVID-19 were evaluated, 102 pre-intervention and 404 post-intervention. Prior to the intervention, 74.5% (n=76) of patients with COVID-19 received empiric antibiotics compared to only 42% of patients post-intervention (n=170), p<0.001. The median DOT in the post-intervention group was 1.3 days shorter (p<0.001) than the pre-intervention group, and atypical antibiotic DOT was reduced by 2.8 days (p<0.001). More patients in the post-intervention group were initiated on antibiotics based on criteria consistent with our guideline (68% versus 87%, p=0.001). There were no differences between groups in terms of clinical outcomes. Conclusion: Following the implementation of a guideline outlining recommendations for initiating and discontinuing antibiotics for CABP among COVID-19 inpatients, we observed a reduction in antibiotic prescribing and DOT. The guideline also resulted in a significant increase in the rate of guideline-congruent empiric antibiotic initiation.

scholarly journals 180. Duration of Therapy and Clinical Outcomes in Adult Oncology Patients with Uncomplicated Coagulase Negative Staphylococcal Bacteremia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S198-S199
Author(s):  
Amanda Fairbanks ◽  
Jessica Li ◽  
Ania Sweet ◽  
Frank Tverdek ◽  
Catherine Liu
Keyword(s):  
Blood Culture ◽  
Clinical Outcomes ◽  
Blood Cultures ◽  
Cancer Center ◽  
Cell Transplant ◽  
Inclusion Criteria ◽  
Negative Blood Culture ◽  
Duration Of Treatment ◽  
Hematopoietic Stem ◽  
Antibiotic Duration

Abstract Background Although they are often considered contaminants, coagulase negative staphylococci (CoNS) can be pathogens especially in immunocompromised patients. National and local guidelines recommend treatment durations of 7 to 14 days, depending on specific clinical scenarios. The objective was to characterize the duration of treatment for CoNS bacteremia and clinical outcomes at our cancer center. Methods We conducted a retrospective chart review of adult patients ≥18 years old with ≥1 blood culture with growth of CoNS between 1/1/17 and 12/31/19 at our cancer center. Patients with complicated CoNS bacteremia and polymicrobial infections were excluded. Results Among 128 patients identified during the study period, 98 met inclusion criteria (Figure 1). Most patients (N= 92; 94%) had a hematologic malignancy as the underlying oncologic diagnosis, and 68 (69%) were hematopoietic stem cell transplant recipients. The median total antibiotic duration was 13 days, and median duration from the date of 1st negative blood culture was 12 days; 29 (30%) patients were treated for a total duration of &gt;14 days (Figure 2). The catheter was retained in 67 (68%) and exchanged in 4 (4%) of the cases. Three (3%) patients had recurrence of bacteremia within 30 days of treatment completion, and 8 (8%) patients were transferred to the ICU within 7 days of the index blood culture. The 30-day crude mortality rate was 10%. The most commonly used antibiotic for treatment was vancomycin (N= 95; 97%), and 32 (34%) patients on vancomycin had an increase in serum creatinine of ≥ 50% from baseline. Five (5%) patients discontinued vancomycin due to nephrotoxicity, and 4 (4%) patients required hemodialysis. Figure 1. Results Overview Among 128 patients identified during the study period, 98 met inclusion criteria. Of those included, 36 had one set of blood cultures that were positive for CoNS and 62 patients had at least two sets of blood cultures that were positive for CoNS. Figure 2. Duration of Antibiotic Treatment We evaluated duration of treatment based on total antibiotic duration and duration from date of 1st negative blood culture. The number of patients is noted above each bar. Conclusion Although the majority of patients were treated for ≤14 days for uncomplicated CoNS bacteremia, nearly 1/3 of patients were treated for &gt; 14 days. Recurrent bacteremia was uncommon despite catheter retention in most patients. Relatively high rates of vancomycin associated nephrotoxicity highlight opportunities for antimicrobial stewardship to limit duration of vancomycin therapy among cancer patients with uncomplicated CoNS bacteremia. Disclosures All Authors: No reported disclosures

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