273 - Comparative Effectiveness of Ampicillin in the Treatment of Enterococcus faecalis Bloodstream Infections in Patients With Cancer

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Co-Author(s)

JS

J.P. Sanchez

PGY2 Oncology Pharmacy Resident
The University of Texas MD Anderson Cancer Center
Houston, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GC

German Contreras

Infectious Diseases Fellow
University of Texas Medical Branch
Galveston, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TT

Truc T. Tran

Assistant Professor
Center for Antimicrobial Resistance and Microbial Genomics, UTHealth, Houston, TX,
Houston, TX
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SS

Shelby R. Simar

Graduate Research Assistant
University of Texas Health Science Center-Houston
Houston, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Blake M. Hanson

Assistant Professor
The University of Texas Health Science Center
Houston, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KM

Kayleigh Marx

Clinical Pharmacy Specialist - Leukemia
The University of Texas MD Anderson Cancer Center
Houston, TX
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MZ

Marcus Zervos

Division Head of Infectious Diseases
Henry Ford Hospital
Detroit, Michigan
Disclosure: Melinta Therapeutics (Grant/Research Support)
KR

Katherine Reyes

Director, Infection Prevention and Control
Henry Ford Health System
Detroit, MI
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JM

Jose M. Munita

Associate Professor
Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Genomics and Resistant Microbes (GeRM) Group. Clínica Alemana de Santiago, Universidad del Desarrollo School of Medicine
Santiago, Region Metropolitana, Chile
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Samuel A. Shelburne

Professor
MD Anderson-University of Texas
Houston,, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CA

Cesar A. Arias

Professor
Houston Methodist Hospital, Center for Infectious Diseases Research, Houston Methodist Research Institute
Houston, Texas
Disclosure: Entasis Therapeutics (Scientific Research Study Investigator)MeMed (Scientific Research Study Investigator)Merck (Grant/Research Support)

Presenting Author(s)

Samuel L. Aitken

Clinical Pharmacist Specialist
Michigan Medicine
Ann Arbor, MI
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: E. faecalis (Efc) isolates are usually susceptible to ampicillin (AMP). AMP-based regimens are the standard of care for enterococcal infections, although other antibiotics are often used as definitive treatment. We thus compared outcomes of patients with cancer and Efc bacteremia treated with AMP-containing (ACR) and non-AMP-containing antibiotic regimens (NACR).

Methods: A multicenter, prospective, observational cohort study conducted at MD Anderson Cancer Center, Henry Ford Hospital, and Memorial Hermann Health System. Eligible patients were ≥ 18 years old, diagnosed with cancer, and had at least one Efc bloodstream isolate collected from 12/2015 to 12/2018. Patients with polymicrobial infections were excluded. Patients were divided into two groups: i) ACR and ii) NACR. ACR included patients who received AMP at any time during treatment; other antimicrobials were permitted. NACR patients did not receive AMP at any time. The primary outcome compared desirability of outcome ranking (DOOR) between ACR and NACR at day 14. The DOOR consisted of six hierarchical levels: 1 - death; 2 - inpatient without microbiological cure (MC) and with acute kidney injury (AKI); 3 - inpatient without MC and without AKI; 4 - inpatient admitted with MC and with AKI; 5 - inpatient with MC and without AKI; 6 - alive and discharged. Comparison of DOORs between ACR and NACR was performed using inverse probability of treatment weighted (IPTW) ordered logistic regression.

Results: Seventy-one patients were included (ACR, n = 35; NACR, n = 36). No difference was seen in DOORs at day 14 between ACR and NACR (odds ratio [OR] 1.14, 95% Confidence Interval [CI] 0.45 – 2.92, p=0.78). No difference was observed for all-cause mortality at day 14 (OR 0.6, 95% CI 0.09 – 3.77, p=0.58) or day 30 (OR 0.42, 95% CI 0.09 – 1.94, p=0.27). Patients treated with ACR received a lower median duration of other antibiotics at any point during treatment compared to NACR: daptomycin (2 v 4 days) vancomycin (2 v 4 days), and linezolid (1 v 2 days).

Conclusion: Patients with cancer and Efc bloodstream infections had similar outcomes when treated with ACR and NACR. ACR were associated with less use of broad-spectrum antimicrobials. Future research should focus on the ecologic impact of use of NACR.