259
￭ Sat-411 ￭
Risk factors for mortality in patients with CRE bacteremia in South Korea
1연세대학교 의과대학 신촌세브란스병원 내과학교실, 2연세대학교 의과대학 AIDS research Institute
*
안상민
1, 조윤숙
1, 현종훈
1, 이용섭
1, 손유진
1, 이운지
1,2, 김준형
1,2, 성혜
1,2, 김정호
1,2, 정수진
1,2, 구남수
1,2, 최준용
1,2, 염준섭
1,2, 안진영
1,2 Background/Aims: Carbapenem resistance among gram-negative bacilli is a great concern worldwide. The aim of this study was to identify character- istics, outcomes and risk factors for mortality of adult patients with Carbapenem-Resistant Enterobacteriaceae (CRE) bacteremia. Methods: We reviewed all cases with CRE bacteremia between September 2017 and January 2019 at a 2,500- bed tertiary care hospital in South Korea. A case-control study was conducted to identify risk factors for 7- and 28-day mortality of CRE bacteremia. Results: Among 80 CRE bacteremias, 63 (78.8%) were found to express carbapenemase (KPC, 48; NDM, 14; OXZ, 1). 75 isolates (93.8%) were susceptible to amikacin. 7- and 28-day mortality rates were 23.8% and 41.3%respectively. In logistic regression analysis, underlying hematologic malignancies (odd ratio [OR], 19.099; 95% confidence interval [CI], 1.634-223.295;
p=0.019) and septic shock (OR, 7.951; 95% CI 2.026-31.204; p=0.003) were independent risk factors, whereas amikacin-based therapy (OR, 0.030; 95% CI 0.003-0.280; p=0.002) were negative predictors for 7-day mortality. Septic shock (OR, 3.717; 95% CI 1.349-10.238; p=0.011) was still an independent risk factors for 28-day mortality, however underlying hematologic malignancies or amikacin-based therapy were not significantly associated with 28-day mortality. After Cox regression analysis, septic shock (hazard ratio [HR], 2.788; 95% CI 1.355-5.736; p=0.005) and underlying hematologic malignancies (HR, 3.482; 95% CI 1.351-8.973; p=0.010) were significantly associated 28-day mortality. Amikacin-based therapy (HR, 0.295; 95% CI 0.127-0.683;
p=0.004) was associated with lower 28-day mortality Conclusions: At this institute, CRE bacteremia in patients with underlying hematologic malig- nancies was shown to be important risk factors for mortality. Amikacin-based therapy can be considered for reduction the risk of mortality in amikacin sus- ceptible CRE bacteremia
￭ Sat-412 ￭
Differences in characteristics and pathogens between CLABSIs and CRBSIs in medical ICU
연세대학교 의과대학 내과학교실
*
현종훈, 손유진, 조윤숙, 이용섭, 안상민, 이운지, 김정호, 성혜, 정수진, 구남수, 최준용, 염준섭, 안진영
Background/Aims: The surveillance definition of central line-associated bloodstream infection (CLABSI) could overestimate the central venous catheter (CVC) as the source of bloodstream infection. The definition of catheter-related bloodstream infection (CRBSI) by the Infectious Diseases Society of America is a more specific definition that identifies the CVC as the source of infection. In this study, we used modified definitions of CRBSI and compared clinical characteristics and causative pathogens between CLABSIs and CRBSIs. Methods: We retrospectively reviewed all CLABSI data reported in the 30-bed medical intensive care unit (ICU) of Severance hospital between January 2017 and December 2018. We defined CRBSI as simultaneous positive re- sults of blood culture drawn from the central line and peripheral site without other focus of infection and excluding mucosal barrier injury-associated labo- ratory-confirmed bloodstream infection. Results: Overall, 105 episodes of CLABSI were reported over 94 patients. Among them, 37 patients meet the di- agnostic criteria of CRBSI. CRBSI group had more extended lCU stay (24.00 days vs. 17.95 days) and catheter indwelling time (46.49 days vs. 26 days).
Emergent catheter insertion (69.7% vs. 41%), localized sign and symptoms of insertion site (88.2% vs. 30.3%) were more frequent in CRBSI group.
Whereas, catheter removal rate for suspected infection was higher in CLABSI group (71.6% vs. 32.3%). Candida species were the most frequently identi- fied causative pathogen followed by Enterococcus species in both groups. However, the proportion of Enterococcus species was lower (21.43 vs. 32.26) in CRBSI group. (Table 1) Despite various efforts to prevent, CLABSI outbreak occurred in the 3rd quarter of 2018. (9.21 per 1,000 catheter line days) However, the incidence of CRBSI was not correlated with CLABSI outbreak. (Figure 1) Conclusions: Our data showed that the current surveillance defi- nition of CLABSI may not always warrant clinical importance. More specified definitions may be necessary to evaluate the effectiveness of interventions or outbreak investigations.
259
￭ Sat-411 ￭
Risk factors for mortality in patients with CRE bacteremia in South Korea
1연세대학교 의과대학 신촌세브란스병원 내과학교실, 2연세대학교 의과대학 AIDS research Institute
*
안상민
1, 조윤숙
1, 현종훈
1, 이용섭
1, 손유진
1, 이운지
1,2, 김준형
1,2, 성혜
1,2, 김정호
1,2, 정수진
1,2, 구남수
1,2, 최준용
1,2, 염준섭
1,2, 안진영
1,2 Background/Aims: Carbapenem resistance among gram-negative bacilli is a great concern worldwide. The aim of this study was to identify character- istics, outcomes and risk factors for mortality of adult patients with Carbapenem-Resistant Enterobacteriaceae (CRE) bacteremia. Methods: We reviewed all cases with CRE bacteremia between September 2017 and January 2019 at a 2,500- bed tertiary care hospital in South Korea. A case-control study was conducted to identify risk factors for 7- and 28-day mortality of CRE bacteremia. Results: Among 80 CRE bacteremias, 63 (78.8%) were found to express carbapenemase (KPC, 48; NDM, 14; OXZ, 1). 75 isolates (93.8%) were susceptible to amikacin. 7- and 28-day mortality rates were 23.8% and 41.3%respectively. In logistic regression analysis, underlying hematologic malignancies (odd ratio [OR], 19.099; 95% confidence interval [CI], 1.634-223.295;
p=0.019) and septic shock (OR, 7.951; 95% CI 2.026-31.204; p=0.003) were independent risk factors, whereas amikacin-based therapy (OR, 0.030; 95% CI 0.003-0.280; p=0.002) were negative predictors for 7-day mortality. Septic shock (OR, 3.717; 95% CI 1.349-10.238; p=0.011) was still an independent risk factors for 28-day mortality, however underlying hematologic malignancies or amikacin-based therapy were not significantly associated with 28-day mortality. After Cox regression analysis, septic shock (hazard ratio [HR], 2.788; 95% CI 1.355-5.736; p=0.005) and underlying hematologic malignancies (HR, 3.482; 95% CI 1.351-8.973; p=0.010) were significantly associated 28-day mortality. Amikacin-based therapy (HR, 0.295; 95% CI 0.127-0.683;
p=0.004) was associated with lower 28-day mortality Conclusions: At this institute, CRE bacteremia in patients with underlying hematologic malig- nancies was shown to be important risk factors for mortality. Amikacin-based therapy can be considered for reduction the risk of mortality in amikacin sus- ceptible CRE bacteremia
￭ Sat-412 ￭
Differences in characteristics and pathogens between CLABSIs and CRBSIs in medical ICU
연세대학교 의과대학 내과학교실
*
현종훈, 손유진, 조윤숙, 이용섭, 안상민, 이운지, 김정호, 성혜, 정수진, 구남수, 최준용, 염준섭, 안진영
Background/Aims: The surveillance definition of central line-associated bloodstream infection (CLABSI) could overestimate the central venous catheter (CVC) as the source of bloodstream infection. The definition of catheter-related bloodstream infection (CRBSI) by the Infectious Diseases Society of America is a more specific definition that identifies the CVC as the source of infection. In this study, we used modified definitions of CRBSI and compared clinical characteristics and causative pathogens between CLABSIs and CRBSIs. Methods: We retrospectively reviewed all CLABSI data reported in the 30-bed medical intensive care unit (ICU) of Severance hospital between January 2017 and December 2018. We defined CRBSI as simultaneous positive re- sults of blood culture drawn from the central line and peripheral site without other focus of infection and excluding mucosal barrier injury-associated labo- ratory-confirmed bloodstream infection. Results: Overall, 105 episodes of CLABSI were reported over 94 patients. Among them, 37 patients meet the di- agnostic criteria of CRBSI. CRBSI group had more extended lCU stay (24.00 days vs. 17.95 days) and catheter indwelling time (46.49 days vs. 26 days).
Emergent catheter insertion (69.7% vs. 41%), localized sign and symptoms of insertion site (88.2% vs. 30.3%) were more frequent in CRBSI group.
Whereas, catheter removal rate for suspected infection was higher in CLABSI group (71.6% vs. 32.3%). Candida species were the most frequently identi- fied causative pathogen followed by Enterococcus species in both groups. However, the proportion of Enterococcus species was lower (21.43 vs. 32.26) in CRBSI group. (Table 1) Despite various efforts to prevent, CLABSI outbreak occurred in the 3rd quarter of 2018. (9.21 per 1,000 catheter line days) However, the incidence of CRBSI was not correlated with CLABSI outbreak. (Figure 1) Conclusions: Our data showed that the current surveillance defi- nition of CLABSI may not always warrant clinical importance. More specified definitions may be necessary to evaluate the effectiveness of interventions or outbreak investigations.
