187. The 30-Day Readmission and 30-Day Mortality of Hemodialysis Patients with Antibiotic-Resistant Gram-Negative Bacteremia

Abstract

BackgroundAlthough antibiotic-resistant (AR) Gram-negative infections are more prevalent in hemodialysis (HD) patients, there are limited data on the impact of antibiotic resistance on clinical outcomes. The primary objective of this study was evaluating 30-day readmission and 30-day all-cause mortality of HD patients with AR-Gram-negative bacteremia (GNB). The secondary objective was assessing the association of risk factors for AR-GNB and Infectious Diseases (ID) consult with the primary outcomes.MethodsThis was a single-center, retrospective, cohort study, which enrolled adult HD patients with AR-GNB between January 1, 2010 and December 31, 2018. The AR included extended-spectrum β-lactamase (ESBL), carbapenem resistance (CR; resistant to at least one carbapenem), and multidrug resistance (MDR; resistant to at least one agent in three antibiotic classes). The risk factors for AR-GNB included: antibiotic use and long-term care facility stay within 90 days, hospitalization >30 days, central line, urinary catheter, and invasive medical device use, and severe underlying illness. Statistical analysis involved chi-square and Fisher’s exact tests.ResultsA total of 90 patients were included. The most common pathogen and source were Klebsiella pneumoniae (42.2%) and urine (29.5%), respectively. The most common AR was ESBL (39.6%), followed by CR and MDR (both 29.7%). Overall, 30-day readmission and 30-day all-cause mortality were 22% and 38.5%, respectively. Long-term care facility stay within 90 days was more likely associated with 30-day readmission (odds ratio [OR] 3.46, 95% confidence interval [CI], 0.99–12.15; P = 0.048), although it was not observed with multivariate analysis (P = 0.223). Hospitalization >30 days (OR 0.25, 95% CI, 0.1–0.64; P = 0.003) and ID consult (OR 0.13, 95% CI, 0.05–0.36; P < 0.0001) were less likely associated with 30-day all-cause mortality according to multivariate analysis. Overall, MDR was more likely associated with 30-day all-cause mortality than ESBL (P = 0.02) and CR (P = 0.002).ConclusionTo our knowledge, this is the first study evaluating the impact of AR-GNB in HD patients on 30-day readmission and 30-day all-cause mortality. Hospitalization of >30 days and having ID consult were less likely associated with 30-day all-cause mortality.Disclosures All authors: No reported disclosures.