508. Gentamicin Non-susceptibility is Associated with Persistence of Carbapenem-Resistant Klebsiella pneumoniae in the Urinary Tract.

508. Gentamicin Non-susceptibility is Associated with Persistence of Carbapenem-Resistant Klebsiella pneumoniae in the Urinary Tract.

Luterbach Courtney L; Henderson Heather I; Cober Eric; Richter Sandra S; Salata Robert A; Kaye Keith S; Doi Yohei; Watkins Richard R; Bonomo Robert A; Duin David van

Open Forum Infectious Diseases

2019

2019-10-02

Background Urinary tract infection (UTI) is the most common clinical manifestation of carbapenem-resistant Klebsiella pneumoniae (CR Kp). Persistent CR Kp bacteriuria is associated with the spread of CR Kp and antibiotic overuse. Risk factors for persistent CR Kp bacteriuria are uncertain. Methods CRACKLE-1 was a multicenter, prospective study that included 960 patients with at least one carbapenem-resistant Enterobacteriaceae (CRE)-positive culture from December 2011 to June 2016 collected from 18 hospitals encompassing 8 healthcare systems in the Midwestern US and North Carolina. Patients with CR Kp bacteriuria who were discharged alive from index hospitalization were included in the current study, and sporadic (single positive CR Kp urine culture) and persistent (≥2 CR Kp urine cultures during independent hospital admissions occurring at least 2 days apart) cases were compared. Antibiotic susceptibility testing was performed by local laboratories. Amikacin, gentamicin (GENT), and trimethoprim/sulfamethoxazole were included in the analysis based on variance and frequency of testing. The CDC/National Healthcare Safety Network criteria for UTI were used. Results CR Kp was the most common CRE isolate (n = 869, prevalence 91%). In patients with CR Kp , 527 had CR Kp isolated from the urine (prevalence 61%, 95% CI 0.57, 0.64). Of these, 486 patients, of whom 129 (27%) were diagnosed with a UTI, were discharged alive. Notably, 135/486 (28%) patients with CR Kp bacteriuria were readmitted and yielded a second urine culture of CR Kp. Most patients with persistent bacteriuria, 99/135 (73%), were asymptomatic at initial admission. Of these patients, 20/99 (20%) were diagnosed with a UTI at second admission. In multivariable analysis, only GENT non-susceptibility was associated with an increased risk (adjusted OR 1.66, 95% CI 1.10–2.49) of persistent bacteriuria. Persistent bacteriuria was independent of GENT treatment during index hospitalization (GENT was used in 15% of patients). Conclusion Bacteriuria with GENT non-susceptible CR Kp strains was associated with persistent bacteriuria. As this was independent of GENT treatment, GENT resistance determinants may be co-transmitted along with traits that promote bacterial persistence in CR Kp. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

NORTH Carolina; hospital admission; bacteriuria; urine; laboratory; antimicrobial susceptibility; Klebsiella pneumonia; bacteriuria; CENTERS for Disease Control & Prevention (U.S.); urinary tract infections; URINARY organs; urinary tract; health care systems; disclosure; CENTERS for Disease Control & Prevention (U.S.); amikacin; antibiotic overuse; carbapenem resistance; carbapenem-resistant enterobacteriaceae; GENTAMICIN; gentamicin sulfate (usp); gentamicins; health care safety; Klebsiella pneumonia; midwestern united states; persistence; persistence; rales; signs and symptoms; trimethoprim-sulfamethoxazole combination; urinary tract infections; urine culture

Journal Article

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

S246-S246

6

23288957