1067.  Enterococcal Bloodstream Infections in Children-Risk Factors for Mortality 
Session: Poster Abstract Session: Healthcare-Associated Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Enterococcal bloodstream infections are increasingly being described in hospitalized children.  Prior use of antimicrobials (AM) and the placement of IV catheters have been identified as risk factors in adults and children. Thirty-day crude mortality rates in adults are as high as 50%. Much of this morbidity may be due to pre-existing disease. A recent study from our hospital demonstrated a 30-day crude mortality rate of 12% in children with Enterococcal bloodstream infections. We examined the risk factors for mortality in a cohort of patients.

Methods:We employed a retrospective case-controlled study of patients with Enterococcal bloodstream infections in the A.I. duPont Hospital for Children from 2004 to 2010. Each mortality case was matched to 4 controls by age, gender and positive blood culture for Enterococcus.  Clinical data included AM usage, TPN use, ICU exposure, time to culture positivity and hospital acquired infection (HAI).  Data was analyzed using SPSS. 

Results:Eighty patients were included in the analysis [16 cases (8 males): 64 controls (32 males)].  The mean, median and age range of the cases and controls were 6.4yr, 0.78yr (8d-20y) and 6.4 yr, 0.75yr(43d-20y) respectively.  In the univariate analysis (X2, with Yates correction), TPN exposure and ICU exposure were significantly different in cases and controls (p=0.037 and p<0.05).  Odds ratio of mortality was almost 5 times greater in children who received TPN (OR=4.61, 95% CI=1.20-17.75, p=0.026).  There were 11 cases of VRE, however there was no significant difference between cases and controls (p=0.806).  HAI was almost 4 times likely in the cases compared to the controls (OR=3.927, 95%CI=0.82-18.82, p=0.087). Time to positive culture <11 hrs was not a significant factor in mortality (p=0.74).  Cephalosporin exposure was noted more often in the cases than controls (OR=2.07, 95%CI=0.64-6.63, p=0.222).

Conclusion:Children with Enterococcal bloodstream infections have a significant risk for mortality.  Hospital acquisition of Enterococcal bacteremia poses a significant risk for mortality.  Stringent infection control policy should be adhered to.  Use of TPN, a risk factor for mortality in these patients, should be monitored.  Prudent use of Cephalosporins is advisable. 


Subject Category: P. Pediatric and perinatal infections

Joel D. Klein, MD, Pediatrics, Alfred I. duPont Hospital for Children and Thomas Jefferson Medical College of the Thomas Jefferson University, Wilmington, DE and Shannon Chan, Pharm D, Alfred I. duPont Hospital for Children, Wilmington, DE

Disclosures:

J. D. Klein, None

S. Chan, None

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