474: RISK FACTORS FOR EARLY-ONSET MDRO INFECTIONS IN CRITICALLY ILL PATIENTS

Abstract

Introduction: It is well established that multi-drug resistant organism (MDRO) infections are associated with an increase in morbidity and mortality There are limited studies regarding preemptive identification of patients who present with first onset community acquired MDRO infections. The hypothesis of this study was to identify hypothermia, leukopenia, hypotension, and advanced age as patient risk factors for first onset MDRO infections. Methods: This retrospective, case-matched, observational study at a 550-bed academic medical center evaluated inpatients from January 2019 to December 2021. Patients were included if they had a positive culture result for a gram negative bacteria within 48 hours of hospital admission and required ICU level of care. Patients were separated into two groups based upon if they grew an MDRO or not. Results: A total of 130 participants were included with 65 patients assigned to each the MDRO group and the non-MDRO group. Patients were mostly male (56%), white (58%) and 61 ±15 years. Types of infection included pneumonia (47.7%), urinary tract (32.3%), and blood (4.6%). Enterobacterales sp. were most commonly isolated in both groups n=111 (69%) followed by Pseudomonas aeruginosa n=34 (21%). Comorbid conditions were similar between both groups for organ failure, malignancy, and immunocompromised status. The non-MDRO cohort had a higher incidence of recent anti-infective use (60% vs 35.4%, p< 0.008). Pre-specified risk factors of advanced age (> 65 years), leukopenia (white blood cells count < 4,000), and hypothermia (< 36°C) were not significantly different between groups. Hypotension within the first twenty-four hours of admission was higher in the non-MDRO group (80% vs 63%, P< 0.001). Prior to admission residence other than home was an independent predictor of MDRO infection [OR:3.46 (95% CI 1.49-8.07)]. The incidence of therapeutically active empiric anti-infective regimens was significantly higher in the non-MDRO group (94% vs 32%, P< 0.001). Conclusions: Hypothermia, leukopenia, hypotension, or advanced age were not found to be predictors for MDRO infection. Patients in the non-MDRO group received appropriate antibiotic coverage more frequently than the MDRO group but also had more hypotension on admission.