1180. Addition of Chronic Kidney Disease Status to Pitt Bacteremia Score Improves Prediction of Mortality in Patients With Carbapenem-Resistant Enterobacteriaceae Infections
Authors: Henderson Heather , Cober Eric , Richter Sandra S , Salata Robert , Kalayjian Robert , Watkins Richard , Doi Yohei , Kaye Keith , Evans Scott R , Fowler Vance G , Bonomo Robert , Van Duin David 
Published: November 2018

Abstract

Background
Carbapenem-resistant Enterobacteriaceae (CRE) infections are associated with high mortality. The Pitt Bacteremia Score (PBS) was developed and validated to predict mortality in bloodstream infections (BSI). The first goal of this analysis is to evaluate whether PBS also predicts mortality in non-BSI infections. Second, we determine whether adding chronic kidney disease (CKD) as a parameter to PBS improves prediction of mortality.

Methods
The Consortium on resistance against carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE-1) is a prospective multicenter consortium of hospitals. Each patient with CRE infection was included once at the time of the last positive culture episode. Infections were distinguished from colonization using established definitions. Relative risk regression was used to evaluate the association of PBS ≥4 and CKD with 14-day all-cause hospital mortality.

Results
From December 2011 to June 2016, 364 unique patients were included with the following infections: bloodstream (34%), respiratory (20%), urinary (30%), and wound (16%). Median PBS was 3 (IQR: 2–4); 45% of patients had PBS ≥4. CKD was present in 31% of patients with PBS ≥4 and 20% of patients with PBS &lt;4. All-cause mortality within 14 days of the last positive culture episode was 20%. In multivariable analysis, PBS ≥4 was strongly associated with mortality in patients with bacteremia (PBS ≥4 adjusted RR = 6.1, 95% CI 2.5–14.6, CKD aRR = 1.5, 95% CI 0.9–2.3) and in patients with other infections (PBS ≥4 aRR = 14.0, 95% CI 4.3–44.6, CKD aRR = 1.6, 95% CI 1.0–2.7). Adding CKD as a parameter to the PBS improved mortality prediction, specifically in patients with PBS ≥4 (figure).

Conclusion
As expected, PBS ≥4 was predictive of the 14-day risk of hospital mortality in this cohort of CRE bacteremic patients. In patients with other CRE infections, PBS ≥4 was also predictive of mortality. In this cohort, adding CKD to the PBS improved prediction of mortality patients with PBS ≥4.

Disclosures
S. S. Richter, bioMerieux: Grant Investigator, Research grant. BD Diagnostics: Grant Investigator, Research grant. Roche: Grant Investigator, Research grant. Hologic: Grant Investigator, Research grant. Diasorin: Grant Investigator, Research grant. Accelerate: Grant Investigator, Research grant. Biofire: Grant Investigator, Research grant. V. G. Fowler Jr., Merck: Consultant and Scientific Advisor, Consulting fee. Cerexa/Actavis/Allergan: Grant Investigator, Grant recipient. Pfizer: Consultant and Grant Investigator, Consulting fee and Grant recipient. Advanced Liquid Logics: Grant Investigator, Grant recipient. NIH: Grant Investigator, Grant recipient. MedImmune: Consultant and Grant Investigator, Consulting fee and Grant recipient. Basilea: Consultant and Grant Investigator, Consulting fee and Grant recipient.
Karius: Grant Investigator, Grant recipient. Contrafect: Consultant and Grant Investigator, Consulting fee and Grant recipient. Regeneron: Grant Investigator, Grant recipient. Genentech: Consultant and Grant Investigator, Consulting fee and Grant recipient. Affinergy: Consultant and Grant Investigator, Consulting fee and Grant recipient. Locus: Grant Investigator, Grant recipient. Medical Surface, Inc.: Grant Investigator, Grant recipient. Theravance: Consultant, Consulting fee and Speaker honorarium. Green Cross: Consultant, Speaker honorarium. Grifols: Consultant, Consulting fee. xBiotech: Consultant, Consulting fee. Achaogen: Consultant, Consulting fee. Medicines Co: Consultant, Consulting fee. Novartis: Consultant, Consulting fee.
Novadigm: Consultant, Consulting fee. Bayer: Consultant, Consulting fee. Cubist: Consultant, Consulting fee. Debiopharm: Consultant, Consulting fee. Durata: Consultant, Consulting fee. D. Van Duin, Shionogi: Scientific Advisor, Consulting fee. achaogen: Scientific Advisor, Consulting fee. Allergan: Scientific Advisor, Consulting fee. Astellas: Scientific Advisor, Consulting fee. Neumedicine: Consultant, Consulting fee. T2 Biosystems: Scientific Advisor, Consulting fee. Roche: Scientific Advisor, Consulting fee.