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275 Epidemiology of Non-Bloodstream Sterile-Site Infections due to Extended Spectrum ß-Lactamase-producing organisms (ESBLs) within a Detroit Health System

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Ylinne Lynch, BS , Detroit Medical Center, Wayne State University, Detroit, MI
Heather Bowman, BS , Detroit Medical Center, Wayne State University, Detroit, MI
Jennifer Veltman, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Ryan Tansek, BS , Detroit Medical Center, Wayne State University, Detroit, MI
Palaniappan Manickam, MD, MPH , Detroit Medical Center, Wayne State University, Detroit, MI
Odaliz Abreulanfranco, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Dror Marchaim, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Kayoko Hayakawa, MD, PhD , Detroit Medical Center, Wayne State University, Detroit, MI
Sorabh Dhar, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Jing Zhao, PharmD , Detroit Medical Center, Wayne State University, Detroit, MI
Jason M. Pogue, Pharm, D , Detroit Medical Center, Wayne State University, Detroit, MI
Paul Lephart , Detroit Medical Center, Wayne State University, Detroit, MI
George Alangaden, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Keith S. Kaye, MD, MPH , Detroit Medical Center, Wayne State University, Detroit, MI
Teena Chopra, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Background: ESBLs are increasing in prevalence.  However, few data exist regarding the epidemiology of non-bloodstream sterile site infections.   

 

Objective: To describe the epidemiology of non-bloodstream sterile site infections due to ESBLs and risk factors for in-hospital mortality.

Methods: A retrospective study of patients infected with ESBL K. pneumonia or E. coli was performed at Detroit Medical Center between 01/05 and 12/08. Patients were included in the study if they had infections of sterile sites other than the bloodstream and met SIRS criteria.  Sterile sites were defined as ESBL infections of sites including bile, pleural fluid, peritoneal fluid, bone, joints and various site abscesses. Variables abstracted from the patient chart included demographics, co-morbidities, antibiotic exposure, prior hospitalization and mortality. Antibiotic exposure was defined as antibiotic usage in the 30 days prior to culture. Univariate analysis was performed using Fisher’s exact test for categorical values and Wilcoxon’s for continuous variables.

Results: 76 patients were included, 62(82%) with Klebsiella sp. and 14(18%) with E.coli. The most common anatomic sites of infection were wounds (65%), various site abscesses (20%) and pleural/peritoneal fluids (10%). 11 patients (14.5%) died in the hospital.  Patients who died were older than survivors (67 vs. 60 years, respectively, p=0.1).  Females were more likely to die as compared to males (90% vs. 9%; p=0.002). The median Charlson’s index in the patients who died was higher than the survivors (7 vs.6, p=0.06). Patients who died were more likely to have healthcare-associated infection as compared to survivors (82% vs. 49%, p=0.05), were more likely to be admitted to the ICU following culture (45.5%, 12.3% p=0.01) as well as more likely to have dementia (55 % vs. 28%, p=0.09). Patients who died were significantly more likely to have a rapidly fatal McCabe score on admission (55% vs. 3%, P<0.001). 

Conclusions: We identified several characteristics that placed patients with non-bloodstream sterile site infection due to ESBLs at higher risk for mortality, including co-morbid conditions, acquisition of infection in the hospital setting, and acute severity of illness.  Given the high mortality rate for the patients in our study (14.5%), sterile-site infections with ESBL-producing bacteria should be managed aggressively.