ESKAPE PNEUMONIA - NO ESCAPE: EXTENSIVE DRUG RESISTANCE, SEVERE CLINICAL COURSE, AND HIGHER MORTALITY IN CASES OF ESKAPE POSITIVE PNEUMONIA

Abstract

SESSION TITLE: Predicting Outcomes From Pneumonia SESSION TYPE: Original Investigations PRESENTED ON: 10/07/2018 01:00 PM - 02:00 PM PURPOSE: Data regarding the clinical spectrum, antibiotic resistance and mortality in among cases of ESKAPE pneumonia [HAP, HCAP, VAP] is scant. We set out to address the microbial aetiology, antibiotic resistance and treatment outcomes in patients with ESKAPE pneumonia. METHODS: 275 consenting patients with HCAP (n=154, Mean age 57.6 ± 17.16 years; median 60 years; 93 males), HAP (n=84; Mean age 54.56 ± 17.94 years; median 60 years; 47 males), and VAP (n=37; Mean age 43.97 ± 18.54 years; median 45 years; 24 males) presenting to a tertiary care hospital in north India from 2014 to 2016 were prospectively recruited in the study. Data were collected on patient characteristics, microbial aetiology, Charlson comorbidity index (CCI) scores APACHE-II scores, treatment outcomes, and mortality. Multivariate logistic regression analysis and Cox regression analysis were used. RESULTS: Patients in ESKAPE + group had (n=176, Mean age 51.81 ± 18, Median 57.5, Range 67) lower mean and median for age (ESKAPE - group: n=99, Mean age 60.21 ± 17.06, Median 62, Range 70). (F=14.30, p=0.000) ESKAPE + group had lower comorbidities (Mean CCI score 3.26 ± 2.445 (vs 4.62 ± 2.34), Median 3 (vs 5), Range 9 (vs 12); F=20.076, p=0.000) with n=84 patients having CCI score of >3, compared to n=70 in ESKAPE - group. (p=0.000) The mean APACHE-II score was higher in ESKAPE + (19.82 ± 8.031, Median=19, Range=37) compared to ESKAPE - (17.86 ± 7.22, Median=16, Range=32). (F=4.051, p=0.045) Acinetobacter baumannii (71, 26%) was the most commonly isolated bacteria, followed by Escherichia coli (47, 17%), and Pseudomonas spp. (32, 12%). Extensively-drug resistant bacteria (n=116, 42%) isolation was alarmingly high, out of which n=114 (98%) were from ESKAPE + cases. (p=0.000) The mean length of stay in ESKAPE + group was 16.38 ± 12.26 (vs 13.98 ± 8.64). (p=0.086). In ESKAPE + group, 135 cases had the length of stay ≥ 5 days (vs n=74). There were total 89 deaths during the study period, out of which 65 deaths occurred among ESKAPE + cases. (p=0.021). Using multivariate regression analysis and Cox regression model, variables were analysed for predicting and association, respectivley for in-hospital mortality in ESKAPE + group. Significant variables were MDR bacteria (OR=3.579, p=0.008), patients with recent surgery (OR=7.778, p=0.000), APACHE II score ≥20 (OR=9.646, p=0.000; HR=4.791, 95% CI 2.576-8.910, p=0.000), and septic shock (OR=7.246, p=0.00; HR=3.134, 95%CI 1.854 - 5.296, p=0.000). CONCLUSIONS: The disease severity and adverse treatment outcomes in the form increased length of stay and in-hospital mortality were higher in ESKAPE + cases, even in the presence of desirable patient characteristics. CLINICAL IMPLICATIONS: Further research is needed to understand and target mechanisms of resistance. Our results favour the use of empirical antibiotic treatment for pneumonia, covering ESKAPE pathogens. DISCLOSURES: no disclosure on file for Bashir Fomda; No relevant relationships by Rafi Jan, source=Web Response No relevant relationships by Parvaiz Koul, source=Web Response No relevant relationships by Sandeep Kumar, source=Web Response no disclosure on file for Roohi Rasool