1246. Outcomes of Extended Spectrum β-Lactamases Producing Enterobacteriaceae Colonization among Patients Underwent Abdominal Surgery

Abstract

BackgroundTo evaluate the outcomes of surgical patients colonized with extended-spectrum β-lactamases (ESBL) producing enterobacteriaceae (EN).MethodsA prospective cohort study was performed from February 1, 2016 to April 1, 2019. All patients who underwent abdominal surgical procedures were enrolled. Enrolled surgical patients were screened for ESBL EN colonization by rectal swab culture 1 day before and 5 days after surgery. Data collection included clinical characteristics, risk of SSIs, previous hospitalization, and type of surgical procedure, antibiotic prophylaxis and duration, ASA risk class, and 28-day postoperative outcomes, inclusive of SSIs and associated microbiological data.ResultsAmong 360 prospectively enrolled patients, 204 (56%) were male; the abdominal surgical types included 234 (65%) clean-contaminated, 90 (25%) contaminated, and 36 (10%) dirty cases. Pre-op,129 patients (36%) had ESBL EN colonization. Surgical prophylaxis included second-generation cephalosporins (N = 224, 62%), third-generation cephalosporins (N = 92, 25%), and carbapenems (N = 44, 12%). Post-operative SSIs were identified in 51 patients (14.1%) [superficial SSIs (N = 41) and intra-abdominal SSIs (N = 10)] By multivariate analysis, ESBL EN colonization (aOR = 2.4; 95% CI = 1.19–19.91) and dirty abdominal wound classification (aOR = 3.6; 95% CI = 1.94–16.99) were independent risk factors for SSIs. Culture detection of SSI pathogens differed for superficial vs. intra-abdominal SSIs. Pathogens associated with superficial SSIs included Staphylococcus aureus (10/41;24%), Streptococcus spp. (5/41; 12%), Pseudomonas aeruginosa (6/41; 15%) and non-ESBL EN (16/41;39%). In contrast, all 10 cases of intra-abdominal SSIs were attributed to ESBL EN.ConclusionEnteric colonization with ESBL EN was an independent predictor of intra-abdominal SSIs due to ESBL EN, while superficial SSIs were associated with a variety of non-ESBL pathogens. Our study support the need for awareness of the SSI risks associated with ESBL EN. Additionally, the findings support current surgical prophylactic guideline for the use of non-carbapenem among ESBL EN colonizer undergoing abdominal surgery.Disclosures All authors: No reported disclosures.