914 - Epidemiology of Patients with ESKAPE Pathogen Bloodstream Infection in the US Military Health System

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Presenting Author(s)

AV

Alexander C. Vostal

Translational Research Fellow
National Institute of Allergy and Infectious Diseases
Silver Spring, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

MG

Melissa Grance

Statistical Programmer
Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences
Bethesda, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
UC

Uzo Chukwuma

Division Officer
Navy and Marine Corps Public Health Center
Portsmouth, Virginia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CM

Carlos Morales

Clinical Research Manager
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
Rockville, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CL

Charlotte Lanteri

Deputy Program Director
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
Boyds, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KT

Kalyani Telu

SAS Programmer Analyst
Henry M. Jackson Foundation for the Advancement of Military Medicine, In Support of USU Infectious Disease Clinical Research Program
Bethesda, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EP

Edward Parmelee

Chief, Data Operations
Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences
Bethesda, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JP

John H. Powers

Director of Collaborative Research
Clinical Research Directorate, Frederick National Laboratory for Cancer Research
Bethesda, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KM

Katrin Mende

Deputy Director
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
Rockville, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Bloodstream infections (BSI) are associated with both inpatient mortality and substantial morbidity in the United States. We sought to characterize the epidemiology of BSIs with ESKAPE pathogens on patients served by the United States Military Healthcare System (MHS), which actively prospectively captures clinical and microbiological data from US service members and their beneficiaries.

Methods: We performed a retrospective analysis of MHS patients with blood cultures positive for ESKAPE pathogens (E. faecium, S. aureus, K. pneumoniae, A. baumannii, P. aeruginosa, and Enterobacter spp.), as well as Neisseria gonorrhoeae and Raoultella spp. between January 2010 and December 2015. Microbiological data from the Navy and Marine Core Public Health Center was retrospectively collated with clinical and demographic data from the MHS Data Repository.

Results: We identified 7,404 patients who experienced 8,791 episodes of ESKAPE (including N. gonorrhoeae and Raoultella spp.) BSI. The patients were predominately active duty (N=688) or retired (N=2,517) Armed Forces service members and their dependents (N=2,361). Further, 59.4% were male and 47.5% were >65 years old. A total of 5,594 (75.5%) of BSI episodes were associated with hospital admission, with an average length of stay of 14.9 days (SD of 27.5 days) and 47.4% (N=2,650) of those admissions were associated with an ICU stay averaging 8.6 days (SD of 18.0 days). The most common pathogens detected were E. coli (34.6%, N= 3,042) followed by S. aureus (28.0%,N=2,464), with 7.6% and 40.7% of isolates resistant to ceftriaxone and methicillin, respectively. We found a larger proportion of E. coli BSI in females (47.4% versus 26.2%) and S. aureus BSI in males (32% versus 21.9%). The frequency of A. baumannii BSI in younger patients, ages 18-30, was an average 4.5 fold higher than in older age groups (30-50, 50-65 and >65).

Conclusion: We noted epidemiological differences in the burden of ESKAPE pathogen BSIs, in various populations including sex and age specific risk factors in a population served by the MHS. Further work is underway to evaluate risk factors for infection and outcomes with pathogens with in vitro resistance controlling for factors such as age, gender, co-morbid diseases and severity of illness.