2366. Treatment Characteristics and Predictors of Mortality in Patients With Infected Chronic Pressure Ulcers in Detroit

Abstract

BackgroundInfected chronic pressure ulcers (ICPUs) are difficult to treat and associated with poor patient outcomes. The objective of this study was to describe ICPU management characteristics and to identify risk factors for all-cause 30-day mortality at a large urban health-system.MethodsThis was an IRB approved, cross-sectional study of adult patients with an ICPU diagnosis who were hospitalized and treated with systemic antimicrobials from June 2013–June 2017. The primary study endpoint was all-cause 30-day mortality after or at discharge. Patient, infection, and treatment characteristics were compared between groups.Results225 patients were included: median (IQR) age was 69 (55–83) years and 54% were male. 192 (85%) patients had at least 1 infection-related symptom. Most common ICPU sites were: 132 (59%) sacrum, 41 (18%) lower extremity, 29 (13%) ischium, 4 (2%) other location, and 19 (8%) multiple sites. 207 (92%) of ICPUs were staged in the medical record: 10 (4%) stage II, 26 (12%) stage III, 112 (50%) stage IV, and 68 (30%) unstageable. 189 (84%) patients had ICPU cultures obtained: 107 (56%) were quality cultures, 48 (25%) were superficial/unknown culture type, and 35 (18%) had both. 161 (71%) patients received concomitant surgical intervention, and the majority received empiric antibiotic therapy with anti-MRSA (210, 93%) and anti-pseudomonal (186, 83%) agents. Organisms were identified in 131 (58%) patients, and antimicrobial de-escalation was performed in 38 (40%) patients without cultures or who were culture-negative. The median (IQR) duration of antibiotic treatment was 18 (10–36) days. 46 (20%) patients died within 30-days of or at discharge. When accounting for severity of illness and functional status, obtaining quality ICPU cultures was protective against 30-day all-cause mortality (Table 1). Of eligible patients, 58/183 (32%) were re-hospitalized for any reason 30-days post discharge, and 21/58 (36%) were re-hospitalized secondary to ICPU.ConclusionGeneral ICPU management is varied and empiric broad-spectrum antimicrobials are frequently used. Patients with ICPUs frequently had poor outcomes. Obtaining quality ICPU cultures was associated with decreased mortality and may help clinicians guide appropriate antimicrobial therapy. Disclosures S. L. Davis, Achaogen: Scientific Advisor, Consulting fee. Allergan: Scientific Advisor, Consulting fee. Melinta: Scientific Advisor, Consulting fee. Nabriva: Scientific Advisor, Consulting fee. Zavante: Scientific Advisor, Consulting fee.