670. Real-life Experience of Imipenem-cilistatin-relebactam for the Treatment of Extensively Drug-resistant and Difficult-to-treat Pseudomonas Infections

Abstract

Abstract Background Imipenem-cilistatin-relebactam (Recarbrio) is recommended to treat extensively drug-resistant (XDR) and difficult-to-treat (DTR) Pseudomonas aeruginosa (PA). Since approval in 2019, there remains limited literature describing real-world use. We describe our experience and evaluate the efficacy and safety of Imipenem-cilistatin-relebactam for the treatment of XDR and DTR Pseudomonas infections. Methods This was a retrospective, observational study at a 1,550 licensed-bed academic hospital. Adults receiving ≥72 hours of Imipenem-cilistatin-relebactam for Pseudomonas infections between January 2020-February 2022 were included. The primary outcome was clinical success. Secondary outcomes included 30-day all-cause mortality, 30-day recurrence, 60-day infection-related hospital readmission, and adverse effects. Descriptive statistics were used to analyze our findings. Results Ten patients were included, with 60% being male and a median age of 63 years (range 31-85). The median duration of treatment was 7 days (range 4-14). Sources of infection included ventilator-associated pneumonia (70%), empyema (20%), and bacteremia (20%). Two isolates were XDR, and seven DTR, including an isolate positive for Verona-integron-borne Metallo-β-lactamase (VIM). At the time of index culture, the median APACHE II score was 25.5 and 60% had at least one concomitant infection. For our primary outcome, 7 patients (70%) achieved clinical success. All-cause mortality at 30 days was 30% and 3 out of 8 patients had recurrent infection within 30 days. Conclusion Our study demonstrates the real-life use of Imipenem-cilistatin-relebactam for the treatment of XDR and DTR Pseudomonas infections. While the majority of patients achieved clinical success, a high mortality and recurrence rate was still observed. Larger studies are needed to validate our initial findings. Disclosures All Authors: No reported disclosures.