122. Evaluation of Early Clinical Failure Criteria in Patients with Enterococcus Species Bloodstream Infection

Abstract

BackgroundEarly clinical failure criteria (ECFC) were recently proposed to predict poor clinical outcomes in patients with Gram-negative bloodstream infections (BSI). ECFC are measured between 72 and 96 hours from collection of index blood culture (Table 1). The objective of this study was to evaluate the performance of ECFC in predicting 28-day mortality in patients with Enterococcus spp. BSI.MethodsThis IRB-approved, retrospective, observational cohort study included adult patients hospitalized at Prisma Health–Midlands hospitals from January 1, 2015 to July 31, 2018 with a monomicrobial BSI due to Enterococcus spp. Patients with a previous episode of Enterococcus spp. BSI within one year prior to index culture or those who died within 72 hours were excluded. Multivariate logistic regression was used to examine the association between ECFC and 28-day all-cause mortality. The area under the receiver operating characteristic (ROC) curve was used to measure model discrimination.ResultsA total of 157 patients with Enterococcus spp. BSI were included. Overall, the median age was 66 years, 96 (61%) were men, and 106 (68%) had community-onset BSI. The urinary tract was the most common source of infection (45; 29%), followed by intraabdominal infections (34; 22%). Twenty-eight patients (18%) died within 28 days of BSI. After adjustments for age and Charlson Comorbidity Index, every one-point increase in the ECFC was associated with an 80% increase in the odds of 28-day mortality (OR 1.8, 95% CI 1.3–2.4, P < 0.001). Mortality increased from 4% in patients with ECFC of 0 to 11%, 28%, and 38% as ECFC increased to 1, 2, and ≥3, respectively. The area under ROC curve of ECFC model in predicting 28-day mortality was 0.74 with ECFC of 2 identified as the best cutoff point. Mortality was 8% in patients with ECFC < 2 compared with 33% in those with ECFC ≥2 (P < 0.001).ConclusionECFC demonstrated good discrimination to predict 28-day mortality in hospitalized adult patients with Enterococcus spp. BSI. These criteria may have utility as a stratification or randomization tool in future clinical investigations evaluating optimal antimicrobial treatment duration or effectiveness of intravenous to oral switch therapy in uncomplicated Enterococcus spp. BSI. Disclosures All authors: No reported disclosures.