Critical Care |

Risk Factors for Multidrug Resistant Infections in Critically Ill Patients FREE TO VIEW

Rajiv Sonti, MD; Megan Conroy, MD; Daniel Jamieson, MD
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Georgetown University Hospital, Washington, DC, DC

Chest. 2015;148(4_MeetingAbstracts):233A. doi:10.1378/chest.2250843
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SESSION TITLE: Critical Care Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The origin of infection in critically ill patients often remains speculative, and frequently sepsis is culture-negative. Empiric antibiotic coverage is based on prior culture data, suspected site of infection, and severity of illness. Though clearly these are important, we seek to identify factors that place patients at additional risk to harbor particular organisms. Presented is a comparison of Acinetobacter baumanii and MRSA infections in the intensive care unit, both known to increase morbidity and mortality.

METHODS: This is an observational study using retrospective data. We identified patients with multi-drug resistant (MDR) infections in a medical intensive care unit in a tertiary care hospital from 2008 - 2014. We compared demographic information, past medical history, illness severity and variables related to the patients hospital course between patients with MDR gram positive and MDR gram negative infections (presented in this abstract are initial findings, A. baumanii vs. MRSA). Continuous variables were analyzed by the Student t-test and discrete variables by Pearson Χ2-test using a Bonferroni correction to account for a familywise error rate.

RESULTS: Twenty-three patients with MDR A. baumanii and 26 with MRSA were identified in the 7-year study period. Those ultimately proven to have A. baumanii infections were more likely to have chronic O2-dependent pulmonary disease (7 vs. 1, p=.027), whereas patients with MRSA had a higher frequency of indwelling central venous lines (3 vs. 9, p=.042). No differences were seen in immunosuppression, nursing home residency, chronic hemodialysis, CHF, liver disease, APACHEII scores, hospital length of stay or duration of antibiotic exposure between the two groups; though there were trends in the prevalence of type 2 diabetes (11 vs. 5, p = .06) and surgery within the last year (4 vs. 1, p = .072).

CONCLUSIONS: The presence of underlying pulmonary disease or indwelling lines may represent additional surrogate markers for the presence of A. baumanii vs. MRSA infections.

CLINICAL IMPLICATIONS: Practice patterns dictate the initial use of broad-spectrum antibiotics, followed by de-escalation at a time when culture data is known or clinical stability is achieved. If the trends presented hold over our entire dataset and are reproducible in other settings, clinicians may have more information with which to make decisions regarding “tailoring” antibiotics, potentially leading to more judicious use.

DISCLOSURE: The following authors have nothing to disclose: Rajiv Sonti, Megan Conroy, Daniel Jamieson

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