898. Development of Risk Score to Guide Therapy for Carbapenem-resistant Pathogens


 
 
 Carbapenem resistance is a major concern of the World Health Organization (WHO) and Centers for Disease Control (CDC). The mortality in carbapenem-resistant infection ranges from 26-44%. Delays in appropriate antibiotic therapy can lead to increased mortality and longer hospital stay. Studies have identified several risk factors associated with carbapenem resistance including mechanical ventilation, indwelling devices, recent invasive surgery, severity of illness, recent hospitalization, and prior antibiotic exposure. However, most of these studies include Enterobacterales and not Acinetobacter baumannii or Psuedomonas aeruginosa. Therefore, we aimed to identify risk factors associated with carbapenem resistance to all pathogen types and develop a risk scoring tool.
 
 
 
 This was an observational nested case-control study of hospitalized patients from January 2016-2022. Risk factors were compared for patients with culture-confirmed carbapenem-resistant gram-negative (GN) organisms (CRO) vs culture-confirmed carbapenem-susceptible GN organisms (CSO). Using accumulated data and logistic regression backwards-stepwise analysis, a scoring tool was created with c-statistic validation performed on a 75% subsample.
 
 
 
 There were 1,020 CRO and 51,157 CSO patients identified. Patients were primarily female (70.6%) with a mean age of 61 years. The most common CRO site of infection was respiratory (47.1%) followed by urine (29.0%). CRO pathogens included Pseudomonas (66.6%), Acinetobacter (18.9%), and Enterobacterales (14.5%). Included risk factors in the final tool were age 46-79 years, male sex, prior admission, prior invasive procedure, prior antibiotic use, admission unit, APACHE II score, chronic diseases (cardiovascular, liver, renal, respiratory), infection site, and nosocomial infection (c-statistic, 0.879). A separate scoring tool was created to include pathogen type, once identified, improving the accuracy of the scoring tool (c-statistic, 0.941).
 
 
 
 Utilizing obtainable risk factors, a straightforward scoring tool can be used to predict carbapenem resistance to, provide guidance for treatment decisions. Further validation of scoring tool is warranted.
 
 
 
 All Authors: No reported disclosures.
