1545. Gram-Negative Bacteremia in Neutropenic Patients: Risk Factors for Mortality in the Era of Multiresistance. (26th November 2018) - Herrera, Fabián
Abstract: Background: Gram-negative bacteremia (GNB) in neutropenic patients is a major cause of infection-related mortality. Our objective was to identify factors associated with 7-day and 30-day mortality during GNB episodes in neutropenic patients. Methods: Prospective multicenter study. Episodes of GNB in adult neutropenic cancer and hematopoietic stem cell transplant (HSCT) patients were included in 10 centers of Argentina, from May 2014 to January 2018. To identify factors associated with 7-day and 30-day mortality, variables with P < 0.05 in univariate analysis were included in a logistic regression model for multivariate analysis. Results: Four hundred and seventy-six episodes of GNB were included. From these, 68.06% had hematological malignancies, 22.90% HSCT and 9.03% solid tumors. Seven-day and 30-day mortality were 19.53 and 26.47%, respectively. In multivariate analysis, factors independently associated with 7-day mortality were: Meropenem-resistant GNB (OR 8.60, 95% CI 3.06–24.14, P ≤ 0.0001), respiratory source (OR 3.67, 95% CI 1.21–11.10, P = 0.021), skin and soft tissue source (OR 3.89, 95% CI 1.01–14.94, P = 0.048), Charlson score > 4 (OR 2.76, 95% CI 1.06–7.19, P = 0.037) and shock (OR 7.13, 95% CI 2.50–20.33, P ≤ 0.0001). Independent factors for 30-day mortality were: Meropenem-resistant GNB (OR 7.06, 95% CI 2.83–17.64, P ≤ 0.0001), respiratory source (OR 4.41, 95% CI 1.53–12.73, P = 0.006), skin and soft tissue source (OR 3.66, 95% CI 1.00–13.42, P = 0.049), Charlson score > 4 (OR 3.81, 95% CI 1.62–8.91, P = 0.002), intensive care unit requirement (OR 2.46, 95% CI 1.00–6.04, P = 0.049), shock (OR 10.90, 95% CI 4.12–29.85, P ≤ 0.0001) and refractory cancer (OR 4.30, 95% CI 1.57–11.78, P = 0.005). Conclusion: The identification of certain prognostic factors would allow the stratification of neutropenic patients at high risk for mortality during GNB episodes. The appropriate medical intervention of a multidisciplinary team on these factors could improve the outcome of these patients. Since Meropenem-resistant GNB is one of strongest prognostic factors, it is essential to identify the patients at risk and treat them appropriately. Disclosures: All authors: No reported disclosures.