Abstract
Background
According to the IDSA guidelines, most asymptomatic bacteriuria should not be treated. The identification of drug resistance often leads to inappropriate antibiotic prescribing. We evaluated prescribing patterns of vancomycin-resistant enterococci (VRE) and vancomycin-susceptible enterococci (VSE) at a regional health system to determine whether the rates differ by institution.
Methods
This is a retrospective chart review of all adult inpatients at the St. John Providence Health System (SJPHS) with positive urine culture identified as VRE or VSE between April 1, 2017 and October 1, 2017. The groups were matched to hospital location, age within 5 years and gender. Patients with medical records that were not available were excluded. Patient demographics (age, sex), location of patient (institution), ID consult, fever, treatment, antibiotic class and the duration of treatment was collected. Bacteriuria was defined as a UTI if there was fever or enterococcal bacteremia. We evaluated frequency of treatment as well as type and duration of antibiotics.
Results
208 patients with VRE bacteriuria at SJPHS were identified and 106 met our inclusion criteria. 1,304 of VSE bacteriuria at SJPHS were identified and 106 were matched. The mean age was 70.4 and 71.3 (P = 0.476) in the VRE and VSE groups respectively and each group had 35.8% males. The table below depicts the number of patients with VRE/VSE being treated by institution.
| Site | Included | ID Consult | Number Treated | Fever | (+) BCx | Median length of Rx (days) |
|---|---|---|---|---|---|---|
| Hospital 1 | 22/22 | 20/14 | 5/4 | 8/4 | 2/2 | 7/14.5 |
| Hospital 2 | 47/47 | 40/27 | 15/21 | 8/5 | 0/0 | 7/7 |
| Hospital 3 | 5/5 | 4/3 | 1/2 | 2/0 | 0/0 | 7/13 |
| Hospital 4 | 22/22 | 16/13 | 5/12 | 3/3 | 0/1 | 7/7 |
| Hospital 5 | 10/10 | 9/5 | 4/6 | 2/3 | 0/0 | 6.5/8.5 |
| Total | 106/106 | 89/62 (P < 0.0001) | 30/45 (P = 0.0085) | 23/15 (P = 0.21) | 2/3 | 7/7 |
Therapy for VRE was diverse among most institutions and included agents such as daptomycin, β-lactams, doxycycline, fosfomycin, nitrofurantoin and linezolid. Hospital 2 had a total of 15 treated cases; 11 of which were treated with linezolid. Therapy for VSE primarily consisted of β-lactam or vancomycin.
Conclusion
The rates of treatment were higher with VSE compared with VRE. ID was more frequently consulted in patients with VRE and those patients were treated less frequently.
Disclosures
All authors: No reported disclosures.
Session: 250. Treatment of AMR Infections
Saturday, October 6, 2018: 12:30 PM