Abstract
Abstract
Background
Extended spectrum β-lactamase producing Enterobacteriaceae are concerning for appropriate anti-infective treatment. The CDC estimates 1,700 deaths per year and $40,000 in excess hospital costs/ESBL bacteremia. This study evaluated appropriateness of treatment regimens used for ESBL-producing bacteria within the CHI Omaha health system.
Methods
Hospitalized patients were identified by the Microbiology Department within CHI Health System for 2015. Patients > 18 years of age were included in the study if culture results determined an ESBL-producing organism. Treatment appropriateness (TA) was defined as using a carbapenem, (or fosfomycin for UTI only) as definitive therapy. ESBL-production was determined using Clinical Laboratory Standards Institute (CLSI) approved microbiological methods. SPSS (ver 24) was used to analyze the data. A p-value of ≤ 0.05 was considered significant.
Results
A total of 172 patients (107 (62%) female) had positive ESBL-producing organisms and 30% of patients were admitted from nursing homes. E. coli was predominant organism cultured (78%). No differences in sex, age, incidence of diabetes, or chronic kidney disease between TA (n = 114) and treatment inappropriate (TI) (n = 58) patients. Forty-six (27%) patients had bacteremia on presentation. Duration of intravenous (IV) antimicrobial therapy was significantly shorter in TI bacteremia patients (TA 13.4 ± 4.3; TI 6.6 ± 5.1, P < 0.001). A total of 10% of ESBL patients expired. Significantly more TI patients were diagnosed with urinary tract infections (UTI) compared with TA patients [88% vs. 75%, P < 0.05]. Infectious Diseases (ID) was consulted for 65% of ESBL infections. More than two-thirds (40/58) of TI patients did not consult ID (P < 0.001). ID consultation resulted in significantly more appropriate duration of IV therapy (ID consult 12.3 ± 7.7, no ID consult 2.2 ± 2.4 days, P < 0.001). Majority (53%) of hospitalized TI patients were administered oral antimicrobials for definitive UTI therapy.
Conclusion
In patients with ESBL-producing organisms, TA antimicrobial use with ID consultation leads to more appropriate outcomes.
Disclosures
All authors: No reported disclosures.