2664. Impact of Multidrug-Resistant Bacterial Infections in Solid-Organ Transplantation: The Value of Electronic Health Records-Based Registries and Data Extraction Tools

Abstract

BackgroundAntimicrobial usage is the most important driver of antimicrobial resistance. Despite compelling reasons to use antimicrobials judiciously, it has been challenging to implement antimicrobial stewardship programs (ASP) in the solid-organ transplant (SOT) population. The objective of our study is to assess the impact of multidrug-resistant bacterial infections (MDRBI) on the 1-year post-transplant survival in SOT recipients.MethodsIn this retrospective cohort study, we included all patients with a first SOT from January 1, 2010–December 31, 2016 at our institution. Patients were followed for a year. Data extraction tools retrieved information from the electronic health record (EHR) and merged it with data from the Social Security Death Index (SSDI) and Standard Transplant Analysis and Research (STAR) files. Charts of subjects with positive cultures were manually reviewed and adjudicated using CDC/ECDC and CDC/NHSN criteria. The 1-year MDRBI cumulative incidence and survival were estimated using the Kaplan–Meier method and compared using the Log-rank test. A Cox proportional hazards model was used to identify predictors of 1-year mortality. Cytomegalovirus (CMV) Infection, renal replacement therapy (RRT), and post-transplant extra-corporeal membrane oxygenation (ECMO) were analyzed as a time-dependent covariate.Results1,112 SOT recipients met inclusion criteria. Patient characteristics are shown in Table 1. 105 patients had at least one MDRBI. The cumulative incidence of MDRBI was 9.7% (95% CI 14.6–5.9) (Figure 1). The most common MDR pathogens were Vancomycin-resistant Enterococci and E. coli (Figure 2A), and the most common sites of infection were urinary tract infection and pneumonia (Figure 2B). The 1-year post-SOT survival in patients with MDR infection was 75.3% (95% CI 82.8–65.2) (Figure 2C). In multivariable analysis, MDRBI (HR = 6.2 [3.5–10.9]) and post-SOT RRT (HR = 17.8 [10.3–30.6]) were associated with an increased risk of 1-year mortality (Table 2).ConclusionMDRBI significantly impacts the 1-year survival of SOT recipients. Our results highlight the need to strengthen ASP measures in SOT. Additionally, this study illustrates the versatility of EHR-based registries and data extraction tools in the field of transplantation. Disclosures All authors: No reported disclosures.