Resistance in NYC Seven Hospital Consortium

1
Following slides were presented by Louis Rice, MD
on behalf of the Infectious Diseases Society of
America (IDSA) before the FDA Anti-Infective
Advisory Committee, February 20, 2002 (with
permission of Currie, B. first presented at
the 39th Annual Meeting of the Infectious
Diseases Society of America San Francisco,
October 2001)
2
Rahal, et al (2002) Clin. Infect. Dis. 34499-503
3
Imipenemr K. pneumoniae
Ahmad, et al (1999) Clin. Infect Dis. 29352-5
4
Patient RR

• 57 year old male with acute myelogenous leukemia
  diagnosed 12/01 - treated with aggressive
  chemotherapy with initial response. Stool found
  colonized with VRE on this admission.
• Returned with relapse 1/15/02 - simultaneous
  broviac line infection with C. parapsilosis and
  C. glabrata - Amphotericin B begun

5
Patient RR

• 1/26/02 - blood cultures for coagulase-negative
  staphylococci. Clinical exam revealed diarrhea,
  abdominal pain, labs revealed neutropenia and
  thrombocytopenia. Begun on vancomycin,
  metronidazole. Abdominal CT suspicious for
  typhilitis. Meropenem begun.
• 1/31/02 - Persistently febrile, blood culture
  for vancomycin and ampicillin-resistant E.
  faecium - linezolid substituted for vancomycin.

6
Patient RR

• Fevers, abdominal pain gradually subside on
  linezolid therapy.
• 2/14/02 - remains afebrile. WBC now 3,900. Bone
  marrow biopsy clean. But platelets remains less
  than 20,000.

7
Enterococcal bacteremiaVergis, et al Ann Int Med
(2001) 135 484-92
Mortality

• Hematologic malignancy
• Vancomycin resistance
• APACHE II score

Among patients with monomicrobial enterococcal
bacteremia, receipt of effective antimicrobial
therapy within 48 hours independently predicted
survival
8
Resistance in NYC Seven Hospital Consortium
Louis Rice, MD on behalf of the Infectious
Diseases Society of American (IDSA) before the
FDA Anti-Infective Advisory Committee, February
20, 2002 (with permission of Currie, B. first
presented at the 39th Annual Meeting of the
Infectious Diseases Society of America- San
Francisco, October 2001)