P-2283. Reversing Antimicrobial Resistance (AMR) in Febrile Neutropenia. Is it Possible?

Background

Multi-drug resistance in gram-negative bacilli is major cause of concern in managing patients with febrile neutropenia particularly among hematology-oncology patients. Reversing AMR has never been demonstrated previously in this setting.

Table of various parameters comparing Cohort A and B

Methods

This retrospective study compares clinical and microbiological outcomes of patients admitted to hematology-oncology unit of a tertiary care center in India with febrile neutropenia and gram-negative bacteremia. Patients admitted from April 2019- April 2020 were included in Cohort A and April 2023-April 2024 were included in Cohort B.

Bar diagram showing change in resistance pattern in two cohorts

Results

A total of 212 patients (Cohort A: 114, Cohort B 98) were included in this study (Table 1). Mean age (53 ± 21.2 years vs 46.5 ± 17.5; p = 0.417) and gender distribution (females: 40.3% vs 36.7%; p = 0.58) were comparable and so was distribution of malignancies. Mean Sequential Organ Failure Assessment Score (6 ± 2.29 vs 5 ±3.50; p = 0.245), mean Charlson co-morbidity Index (3 ± 2.4 vs 3 ± 2.1; p = 0.65), mean Pitts Bacteremia score (1 ± 1.46 vs 1 ± 1.58; p = 0.334) and 30 day crude mortality (28.7% vs 28.6%; p = 0.935) were not statistically significant between the two cohorts. Incidence (Figure 1)of carbapenem resistance (CR) Klebsiella pneumoniae (56 (90.3%) vs 16 (47.1%); p < 0.01), CR E. coli (14 (43.7%) vs 6 (23.1%); p = 0.099) and DTR (difficult-to-treat) Pseudomonas aeruginosa (10 (83.3%) vs 2 (10.0%); p < 0.01) significantly reduced in Cohort B as compared to Cohort A. Involvement of Infectious Disease (ID) service, following antibiotic stewardship (AMS) team advice, improved diagnostic facility and infection control were major interventions during the study period.

Conclusion

This study highlights that incorporating ID service and following AMS activities along with other infrastructure development can reverse AMR in high risk setting like febrile neutropenia among hematology-oncology patients.

Disclosures

All Authors: No reported disclosures