681. Epidemiology and Outcomes of Patients with Carbapenem-Resistant Bloodstream Infection in United States Hospitals, 2010–2015

Abstract

BackgroundCarbapenem resistance (CR) in patients with Gram-negative (GN) bloodstream infections (BSI) presents a mounting therapeutic challenge. To gain a better understanding of CR among patients in US hospitals, we explored their characteristics and outcomes.MethodsWe performed a retrospective cohort analysis of consecutive adult patients (age ≥18 years) with a positive blood culture for GN pathogens (11 most prevalent pathogens reported in ~53,811 study patient samples), hospitalized in one of 181 institutions contributing microbiology data to the Premier Healthcare Database (October 2010–September 2015). We compared patients with CR vs. carbapenem-susceptible (CS) BSIs based on their characteristics and outcomes. Primary outcome was mortality, and secondary outcomes included post-index culture hospital and ICU lengths of stay (LOS), and likelihood of being discharged home.ResultsOf the ~53,811 study patient samples, 46,381 patients had a GN BSI, with the prevalence of CR occurring at 3.5% (n = 1,602). Compared with patients with CS, those with CR were younger (mean/SD 60.4/17.1 vs. 67.4/16.4 years, P < 0.01), more likely to be male (52.8% vs. 45.9%, P < 0.01), black (22.7% vs. 17.7%, P < 0.01), and had Medicaid as a payor (18.1% vs. 10.9%, P < 0.01). The mean/SD Charlson Comorbidity Index was higher in CR than CS group (2.9/2.5 vs. 2.3/2.5, P < 0.01). Crude mortality was also higher (20.6% vs. 9.7%, P < 0.01) in the setting of CR than CS, as were unadjusted median (IQR) post-index culture hospital (9 [6, 15] vs. 7 [5, 10] days, P < 0.01), and ICU (5 [2, 11] vs. 3 [2, 6] days, P < 0.01) LOS. Patients with CR BSI were less likely to be discharged home than those with CS (32.7% vs. 53.8%, P < 0.001).ConclusionPatients with CR BSIs have lower likelihood of surviving hospitalization or being discharged home, and longer post-index culture hospital and ICU LOS, compared with those with CS BSIs. This highlights the need for better and more preventive and therapeutic strategies aimed at combating GN CR.Disclosures A. F. Shorr, Astellas: Consultant and Speaker’s Bureau, Consulting fee, Research support and Speaker honorariumCidara: Consultant, Consulting fee. Merck & Co.: Consultant and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium. T. P. Lodise Jr., Motif BioSciences: Board Member, Consulting fee.