1006. Demographic, Clinical, Microbiological Characteristics and Outcome of Patients Admitted to the Emek Medical Center with Blood Stream Infection Acquired in LTCF: A 5-Year Surveillance

Abstract

BackgroundResidents from long-term care facilities (LTCF) hospitalized with an acute infectious disease are challenging in terms of diagnosis and treatment, considering atypical clinical presentation are high rate of resistant bacteria,.This study aimed to Characterize patients with LTCF acquired bacteremia (LTCF-B), epidemiology of blood cultures (BC) and potential risk for mortality.MethodsA retrospective study of LTCF residents hospitalized with LTCF-B. Demographic, clinical and laboratory data were collected and analyzed using SPSS 22 and SAS.ResultsOne hundred seventy-seven LTCF residents hospitalized in internal wards were included, mean age 81.6 years, mostly completely dependent, 54.8% were males. Most frequent diagnoses was urinary tract infection (UTI), second by respiratory tract infections. Half were hospitalized during prior 6 months, one-third had a permanent indwelling urinary catheter. On admission, 70% had WBC blood count >10,000 cells/mL. The following pathogens were isolated from BC: Gram-negative enterobacteriaceae (70%): E. coli were 40% and Gram-positive cocci (21%): S. aureus 5.08% (55.5% of them MRSA). Extended-spectrum-β-lactamase (ESBL) producing enterobacteriaceae were in 47.1% BC, clearly document increase during the years, 26% (2010)–63% (2014). Absolute majority of enterobacteriaceae were sensitive to carbapenems and amikacin, half were resistant to gentamycin, second- and third-generation cephalosporins and quinolones. Inappropriate empiric antimicrobial therapy was given to 46.8% of patients with ESBL-producing enterobacteriaceae (P < 0.001). Mortality rates were 21.5% in-hospital and 46.3% day-90 post discharge. Variables associated with mortality: initial diagnosis of skin and soft-tissue infections (SSTI) (OR = 14.44), inappropriate empiric antibiotic (OR = 5.038), high level of urea (OR = 1.017), and nasogastric tube (OR = 4.966). UTI (OR = 0.316) was a protective factor.ConclusionDiagnosis of SSTI, high urea levels, nasogastric tube, and inappropriate empiric antibiotic were associated with in-hospital mortality. The notable increased rate of ESBL-producing enterobacteriaceae should alert physicians to be aware of local microbial resistance profile, especially among LTCFs patients.Disclosures All authors: No reported disclosures.