Original Research
Monday, October 14, 2024
01:00 PM–02:30 PM
Abstract
Introduction: Carbapenem-resistant organisms (CROs) pose significant challenges in the general population, and these challenges are even more pronounced in cancer patients with a heightened risk of infection. Understanding clinical/microbiological outcomes and the risk factors associated with mortality is crucial for effectively managing these infections.
Research Question or Hypothesis: What are the clinical/microbiological outcomes and risk factors associated with mortality of CRO infections in patients with cancer?
Study Design: Retrospective cohort
Methods: Inclusion: adult hospitalized patients with new CRO infections during 1/2018-12/2023 at a 232-bed comprehensive cancer center. Exclusion: duplicates, intrinsically imipenem-resistant organisms (e.g., Proteus spp.), stool isolates, persistent (presence of baseline pathogen on appropriate antibiotic in a post-baseline specimen)/recurrent (the same infection<14days after stopping appropriate antibiotics) infections, colonization, hospice/comfort measure. Patient characteristics and clinical/microbiological outcomes were compared for 30-day-mortality(M) and 30-day-survival(S). Inverse-probability-weighting (IPW)-adjusted multivariate logistic regression was performed to assess association between novel agents and 30-day-M using SPSS v.29.
Results: 157 new infections/160 isolates from 143 patients with median age of 62 years, 57% male, 63% hematological malignancy and 36% solid tumor, 33% history of hematopoietic-stem-cell-transplants or immune-effector-cell-therapy, 39% neutropenia and 52% lymphopenia were included. Pseudomonas aeruginosa was most common (54%) followed by 33% Enterobacterales; 41% from blood, 21% lung, 14% urine. Further resistance developed in 21% of cases (9% on-treatment, 12% after-treatment). 30-day-M was 25%(n=40). Intensive-care-unit (ICU) admission (43%v.11%), do-not-resuscitate/do-not-intubate (DNR/DNI, 83%v.13%), vasopressor (40%v.9%), mechanical ventilation (70%v.15%), renal-replacement-therapy on day 7 (RRT7, 8%v.3%) were significantly higher in 30-day-M v. 30-day-S. 40% received traditional beta-lactams (piperacillin-tazobactam, cefepime, carbapenems; 30%M v.42%S). Only 23% received novel agents (ceftazidime-avibactam, ceftolozane-tazobactam, meropenem-vaborbactam, cefiderocol; 15%M v.25%S). IPW-adjusted multivariate regression controlled for DNR/DNI, ICU, and lymphopenia showed significant decrease in 30-day-M with novel agents (OR 0.293, 95%CI 0.095-0.898).
Conclusion: The low usage rate of novel agents coupled with their association with reduced 30-day-M underscores the importance of promptly initiating these agents when CRO infections are suspected.
Presenting Author
Wonhee So PharmDWestern University of Health Sciences
Authors
Jana Dickter MD
City of Hope Medical Center
Rosemary She MD
City of Hope Medical Center
Katie Tran PharmD
Western University of Health Sciences
Wenjing Zan PharmD
Western University of Health Sciences