Prevalence of Bloodstream Infections in Neutropenic Patients with Bacteriuria. (4th October 2017) - Herc, Erica
Abstract: Background: Neutropenic patients, specifically those with hematologic malignancies, are predisposed to higher rates of bloodstream infections compared with the general population. Neutropenia is also a risk factor for urinary tract related bloodstream infections. We hypothesized that neutropenic patients with asymptomatic bacteriuria have a higher rate of bacteremia compared with the general population. Objectives: To evaluate the incidence of bacteremia in neutropenic patients with bacteriuria and to evaluate prior antibiotic use and presence of urinary symptoms in neutropenic patients with bacteremia from a urinary source. Methods: This study took place in a large midwest tertiary hospital. A retrospective cohort study of all adult patients with AML, admitted February 2010 through November 2013, with subsequent neutropenia (ANC < 500) and positive urine cultures. The primary outcome was the rate of bacteremia with the same organism in neutropenic patients with bacteriuria. Information on microorganism, antibiotic use prior to culture, the presence of symptoms, and the urinalyses in this population were obtained through electronic records using the honest broker. This study was approved by the Institutional Review Board. Results: In the initial cohort of 1, 807 patients with AML, 139 patients had positive urine cultures. Of the 139 patients, 102 were neutropenic; 10/102 (9.8%) of neutropenic patients with bacteriuria developed bacteremia. Enterococcus faecium was the most common pathogen isolated (5/10). Seven of 10 bacteremic patients had no documented urinary symptoms. Seven of 10 of the bacteremic patients either did not receive antibiotics prior to obtaining urine and blood cultures or received antibiotics to which the pathogen was not susceptible. Seven of 10 of the urinalyses obtained tested negative for leukocyte esterase. Conclusion: Approximately 10% of patients who were neutropenic with bacteriuria developed bacteremia. The majority of patients who became bacteremic did not have urinary symptoms or an abnormal urinalysis. This pilot study suggests that neutropenic patients with asymptomatic bacteriuria should be treated with antimicrobials, however, larger studies are necessary to confirm these findings. Disclosures: All authors: No reported disclosures.