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O0298 Community-Onset Healthcare-Associated Bacteraemic

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O0298 Community-Onset Healthcare-Associated Bacteraemic O0298 Community-onset healthcare-associated bacteraemic urinary tract infections in the era of multidrug resistance: similar or even worse than hospital acquired infections? Silvia Gómez-Zorrilla*1, Inmaculada Grau2, Vicente Pintado3, Belén Padilla4, Veronica Rubio5, Lucía Boix Palop6, Manuel Gutierrez7, Maria Del Rocio Gamallo8, José Antonio Martínez Martínez9, María Peñaranda10, Elena Morte11, Jose Luis Del Pozo12, Jazmin Diaz-Regañon13, Diego Lopez13, Patricia Ruiz-Garbajosa3, Antonio Oliver10, Juan P. Horcajada1 1 Hospital del Mar, Parc de Salut Mar, Barcelona, Spain, 2 Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain, 3 Hospital Universitario Ramón y Cajal-IRYCIS, Madrid, Spain, 4 Hospital General Universitario Gregorio Marañón, Madrid, Spain, 5 Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, 6 Hospital Mutua de Terrassa, Barcelona, Spain, 7 Hospital Universitario Marqués de Valdecilla, Santander, Spain, 8 Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain, 9 Hospital Clinic de Barcelona, Barcelona, Spain, 10 Hospital Universitario Son Espases. Instituto de Investigación Sanitaria de Palma (IdiSPa),, Palma de Mallorca, Spain, 11 Hospital Clínico de Zaragoza, Zaragoza, Spain, 12 Clínica Universitaria de Navarra, Pamplona, Spain, 13 Departamento Médico MSD España, Madrid, Spain Background: Community-onset healthcare associated (CO-HCA) infections represent a growing public health problem with increasing rates of multidrug resistance (MDR). The aim of this study was to compare CO-HCA and hospital-acquired (HA) bacteraemic urinary tract infections (BUTI) with special focus on MDR rates and outcomes Materials/methods: A prospective multicenter cohort observational study (ITUBRAS-2 project) was conducted at 14 Spanish hospitals (September-2017 to October-2018). All consecutive CO-HCA and HA-BUTI episodes were included. Epidemiological, clinical and microbiological variables were analyzed. The MDR profile, was defined as nonsusceptibility to ≥1 agent in ≥3 antibiotic classes. Results: 347 episodes were included, 219 (63%) were CO-HCA BUTI. Patients with CO-HCA were older than those with HA-BUTI [76(IQR: 69-83) vs. 68(IQR:60-77); p<0.001] and had a slightly higher Charlson index [6.7(5-8) vs. 6.04(4-8); p=0.075]. No statistical differences were found in the prior use of antibiotics. Causative microorganisms isolated in the cohort were: Escherichia coli 189(54%, 53% MDR), Klebsiella spp. 80(23%, 48% MDR), other Enterobacteriaceae 41(12%, 66% MDR), Pseudomonas spp. 28(8%, 22% MDR) and Enterococcus spp. 13(4%, 31% MDR). E. coli was more frequently isolated in CO-HCA BUTI [129(59%) vs. 60(47%); p=0.03], while Klebsiella spp. were more common in HA-BUTI [40(18%) vs. 40(31%); p=0.008]. A very high percentage of MDR profiles was observed in both groups, with no statistical differences between them [109(50%) vs. 66(52%); p=0.91]. Inadequate empirical treatment was independently associated with MDR profile (OR 5.42; 95%CI 2.67- 11.0), indwelling urinary devices (OR 2.35; 95%CI 1.21-4.57) and septic shock as protective factor (OR 0.30; 95%CI 0.10-0.92). Pitt Score was slightly higher in CO-HCA group [1.68(0-2) vs. 1.28(0-2); p=0.017]. No significant differences were found in mortality rates [18(8.2%) vs. 7(6%); p=0.52). However, in the logistic regression analysis HA-BUTI (OR 1.74; 95%CI 1.05-2.88) and female gender (OR 1.80; 95%CI 1.10-2.92) were independently associated with clinical cure. Conclusions: In our study, 50% of CO-HCA and 52% of HA-BUTI were due to MDR bacteria. No differences in MDR rates nor in mortality were found between both groups. However, HA-BUTIs were associated with a better clinical outcome. These results should be considered in the clinical management of CO-HCA BUTI in the era of MDR. 29TH ECCMID 13-16 APRIL 2019 AMSTERDAM, NETHERLANDS POWERED BY M-ANAGE.COM .
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