1575 - Predictors of Negative Clinical Outcomes among Patients treated with Meropenem-Vaborbactam for Serious Gram-Negative Bacterial Infections: Impact of Delayed Appropriate Antibiotic Selection

The ePoster content is available to users who are logged in.<br><br>Please log in and then come back here to use this button.

Presenting Author(s)

Sara Allosaimy

Research Scientist
Wayne State
Detroit, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

AL

Abdalhamid M. Lagnf

Research Assistant
Anti-Infective Research Laboratory; Wayne State University
Detroit, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SJ

Sarah Jorgensen

Clinical Pharmacist
Sinai Health System
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TJ

Travis J. Carlson

Assistant professor
High Point University
Highpoint, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Jinhee Jo

Assistant Professor
University of Houston
Houston, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Kevin W. Garey

Professor and Chair
University of Houston
Houston, TX
Disclosure: Merck & Co. (Grant/Research Support, Scientific Research Study Investigator)
DA

David Allen

Clinical pharmacist
Inova Fairfax Hospital
Annandale, Virginia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Lilian M. Abbo

Professor of Infectious Diseases; Associate Chief Medical Officer in Infectious Diseases
University of Miami Miller School of Medicine, Miami Transplant Institute and Jackson Health System
Miami, FL
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KD

Kailynn Deronde

Clinical Hospital Pharmacist - Pediatric/Adult Infectious Disease and Antimicrobial Stewardship
Jackson Memorial Hospital
Miami, Florida
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AV

Ana Vega

Clinical Hospital Pharmacist- Infectious Diseases
Jackson Memorial Hospital
Miami, Florida
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Veena Venugopalan

Clinical Associate Professor
University of Florida College of Pharmacy
Gainesville, FL
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SS

Steven Saw

Clinical Pharmacist
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
VA

Vasilios Athans

Clinical Pharmacy Specialist - Infectious Diseases
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Kimberly C. Claeys

Associate Professor
University of Maryland Baltimore
Baltimore, MD
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Wesley D. Kufel

Clinical Associate Professor
Binghamton University School of Pharmacy Sciences
Binghamton, New York
Disclosure: Melinta (Research Grant or Support)Merck (Research Grant or Support)Theratechnologies, Inc. (Advisor or Review Panel member)
MM

Matthew Miller

Clinical Pharmacist
Univeristy of Colorado
Boulder, Colorado
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MV

Michael Veve

Clinical Pharmacy Specialist, Infectious Diseases
University of Tennessee Medical Center
Knoxville, TN
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CY

Chritsine Yost

Clinical Pharmacist
Beaumont Health
Troy, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LA

Lee Amaya

Pharmacy resident
Beaumont Health
Troy, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JO

Jessica Ortwine

Infectious Disease Pharmacist
Parkland Health
Dallas, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TM

Taylor Morrisette

Postdoctoral Research Fellow
Wayne State University
Detroit, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Susan L. Davis

Clinical Professor and Associate Dean for Pharmacy
Wayne State University
Detroit, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MR

Michael J. Rybak

Professor
Eugene Applebaum College of Pharmacy and Health Sciences
Detroit, Michigan
Disclosure: Paratek (Grant/Research Support)

Background: Numerous number of studies have found a positive correlation between delayed appropriate antibiotic therapy and negative clinical outcomes (NCO) in Gram-negative bacterial infections (GNBI). The combination of meropenem with vaborbactam (MVB) received Food and Drug Administration approval for the treatment of complicated urinary tract infections and acute pyelonephritis caused by susceptible organisms in August 2017. We sought to determine the impact of delayed appropriate therapy with MVB on NCO among patients with GNBI.

Methods: Multi-center, retrospective cohort study from October 2017 to March 2020. We included adult patients treated with MVB for >72 hours. We excluded patients who received alternative appropriate antibiotics for GNB prior to MVB and patients with unknown dates for index culture. NCO were defined as 30-day mortality and/or microbiological recurrence. All outcomes were measured from MVB start date. Classification and regression tree analysis (CART) was used to identify the time breakpoint (BP) that delineates the risk of NCO. Multivariable logistic regression analysis (MLR) was used to examine the independent association between the CART-derived-BP and NCO. Variables were retained in the model if P< 0.2 and removed in a backward stepwise approach.

Results: A total of 86 patients were included from 13 institutions in the United States: median(IQR) age 55 (37-67) years, 67% male, and 48% Caucasian. Median(IQR) APACHE II and Charlson Comorbidity index scores were 18(11-26) and 4(2-6), respectively. Common sources of infection were respiratory (37%) and intra-abdominal (21%). The most common pathogens were carbapenem-resistant Enterobacterales (83%). CART-derived BP between early and delayed treatment was 48 hours, where NCO was increased (36% vs.7%; P=0.04). Delayed MVB initiation was independently associated with NCO in the MLR (aOR=7.4, P=0.02).Results of Regression Analysis of Variables Associated With Negative Clinical Outcomes and Delayed Appropriate Therapy with Meropenem-vaborbactam

Conclusion: Our results suggest that delaying appropriate antibiotic therapy with MVB for >48 hours significantly increases the risk of NCO in patients with GNBI. Clinicians must ensure timely administration of MVB to assure best outcomes in patients with GNBI.