164. Analysis of Adult, Hospitalized Patients With Carbapenem-resistant (CR) Gram-Negative Bloodstream Infections (GN-BSIs) due to Lactose Fermenters (LFs) and Non-lactose Fermenters (NLFs): Is There a Difference in Outcomes?

Abstract

BackgroundThe deleterious consequences of BSIs due to CR-GN bacteria among hospitalized adult patients are well described in the literature. However, scant data exist that compares the baseline features and outcomes of patients with CR-GN-BSIs due to LFs relative to those caused by NLFs.MethodsWe performed a retrospective cohort analysis of consecutive hospitalized adult patients (age ≥18 years) in the Premier Healthcare Database (January 2014–June 2018) with GN-BSI due to select LFs (E. coli, Klebsiella spp., Citrobacter spp., Enterobacter spp., and Serratia spp.) and NLFs (Pseudomonas spp., Acinetobacter spp., and Stenotrophomonas spp.). Patients with a diagnosis of cystic fibrosis or who had both LF and NLF GNB on index BSI culture were excluded. Baseline demographics, medical history, comorbidities, hospitalization history, and outcomes were compared between patients with CR-GNB due to LFs and NLFs. Outcomes assessed included composite death (in-hospital death or discharge to hospice), in-hospital mortality, discharge to home, and hospital length of stay post index GNB-BSI culture collection.ResultsOf the 1749 patients with a CR-GNB-BSI due to an LF or NLF, 1505 met study criteria. Of the 1505, 418 (27.8%) were LFs and 1087 (72.2%) were NLFs. The most common LFs were Klebsiella spp. (55.7%) and Enterobacter spp. (25.7%), while Stenotrophomonas spp. (45.2%) was the most common NLF. Overall, groups were highly similar at baseline but patients with CR-GNB-BSIs due to an LF were slightly older and more likely to be in the ICU at index BSI culture collection (table). Outcomes were also comparable between patients with CR-GNB-BSIs due to LFs and NLFs but there were a few notable differences. Composite mortality was higher in patients with GNB-BSIs due to an LF and these patients were also less likely to be discharged home.ConclusionThe findings indicate that CR-GNB-BSIs result in considerable morbidity and mortality irrespective of whether the GNB is an LF or NLF. One in five patients died during their hospitalization and less than half were discharged home. This highlights the need for better and more preventive and therapeutic strategies aimed at combating CR-GNB-BSIs. Disclosures All authors: No reported disclosures.