O0087 Early vs late post-operative bloodstream infections: the multicentre PROBAC COHORT

José Antonio Girón Ortega*1, Pilar Retamar Gentil1, Luis Eduardo Lopez-Cortes1, Laura Poyatos1, Joaquín Lanz1, Pedro Pérez-Crespo1, M.Teresa Pérez2, Jose Mª Reguera Iglesias3, Isabel Fernandez Natal4, Eva Leon5, María Carmen Farinas6, María Ángeles Mantecón7, Fernando Vazquez8, Fernando Barcenilla Gaite9, Clara Natera10, Alfonso del Arco11, Lucía Boix Palop12, Alberto Bahamonde13, Alejandro Smithson Amat14, Jordi Cuquet Pedragosa15, Isabel Gea-Lázaro16, María Carmen Gálvez Contreras17, Juan Manuel Sanchez Calvo18, David Vinuesa García19, Antonio Sánchez-Porto20, Andres Martin-Aspas21, Marcos Guzman22, Berta Becerril Carral23, Esperanza Merino24, Inés Perez-Camacho25, Jesús Rodríguez-Baño26, Miguel Montejo Baranda27, Grupo Probac Reipi/Geih-Seimc/Saei Grupo Probac Reipi/Geih-Seimc/Saei4 Grupo Probac Reipi/Geih-Seimc/Saei Grupo Probac Reipi/Geih-Seimc/Saei428

1Hospital Universitario Virgen Macarena/Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), , 2Hospital Universitario de , 3Hospital Regional de Málaga Carlos Haya, 4Complejo asistencial U. de León, 5Hospital Universitario Virgen de Valme, 6Hospital Universitario Marqués de Valdecilla, 7Hospital Universitario de , 8Hospital Universitario Central de Asturias, 9Hospital Universitario Arnau de Vilanova, 10Hospital Universitario Reina Sofía, Córdoba, , 11Hospital Costa del Sol, (Málaga), , 12Hospital Universitari Mútua de Terrasa, , 13Hospital el Bierzo, Ponferrada (León), 14Hospital de l’Esperit Sant. Santa Coloma de Gramenet, Barcelona, 15Hospital General de , Barcelona, 16Complejo Hospitalario Ciudad de Jaén, 17Complejo Hospitalario Torrecárdenas, Almería, 18Hospital Sas , 19Hospital Clínico San Cecilio, , 20Hospital SAS Línea de la Concepción, Cádiz, 21Hospital Universitario Puerta del Mar, Cádiz, 22Hospital San Juan de la Cruz de Úbeda, Jaén, 23Hospital Punta de Europa, , Cádiz, 24Hospital General Universitario de , 25Hospital de Poniente, Almería, 26Hospital Universitario Virgen Macarena Instituto de Biomedicina de Sevilla (IBiS) - Universidad de Sevilla, 27Hospital Universitario Cruces, 28

Background: Bacteremia after surgery may present with specific characteristics according to the time since the surgical procedure; such features might be helpful for epidemiological purposes and appropriate management. The objective of this study is to analyze the differences between early and late postsurgical BSI.

Materials/methods: Patients from the prospective observational multicentre (27 Spanish hospitals) cohort study of BSI from October 2016 to September 2017 were eligible; the inclusion criterion for this analysis was the antecedent of major surgery in the previous 30 days. BSI were classified as early if occurring in <10 days after surgery and late if otherwise. Clinical and microbiological characteristics were evaluated. Descriptive, bivariate and multivariate (logistic regression) analyses were performed.

Results: A total of 252 BSI were evaluated (153 early and 99 late BSI). Early and late episodes were significantly different in: dementia (5% vs 0, RR:0,59, 95%CI:0,53-0,6; p=0,04), obstructive uropathy (15% vs 51%; RR: 2,3, 95%CI: 1,05-5,27; p=0,01), central catheter (40% vs 75%; RR: 0,41, 95%CI: 0,30-0,56; p<0,001), urinary catheter (48% vs 70%, RR: 0,57, 95%CI: 0,41-0,77; p<0,001) and parenteral nutrition (27% vs 67%; RR: 0,45, 95%CI: 0,45-0,34; p<0,001). According to aetiology, early BSI were more often caused by E. coli (58% vs 40%, p=0.006) and S. aureus (10% vs 3%, p=0.05), and less by coagulase-negative Staphylococcus (15% vs 22%, p<0.001) and Candida spp (2% vs 13%, p<0.001). Differences in clinical presentation (sources and severity), appropriateness of the empirical therapy and outcomes are shown in table 1. Late BSI was not associated with increased mortality after adjusting for confounders (OR= 1,9, 95%CI:0,8-4,9).

Conclusions: Early and late postsurgical BSI differ in risk factors, sources and aetiology but are similar in severity and outcome. Empirical treatment is frequently inactive.