1208. Serious Bacterial Infections in Febrile Infants Younger than 91 Days of Age: Pathogen Incidence and In Vitro Susceptibility Profiles
Session: Poster Abstract Session: Other Bacterial Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background:In 2008, Intermountain Healthcare (IH) implemented an evidence-based care process model (CPM) to standardize treatment of febrile infants 1 to 90 days. The CPM includes antibiotic recommendations based on suspected diagnosis and infant age.   

Objective: Document pathogens responsible for serious bacterial infection (SBI) in febrile infants and evaluate the concordance of CPM antibiotic recommendations with SBI pathogens.

Methods: All IH facilities share a computerized record system, the Enterprise Data Warehouse (EDW). We queried the EDW to identify febrile infants with SBI including bacteremia, meningitis, or urinary tract infection (UTI) and capture culture results in 2004 -2009.  SBI was verified by either a microbiologist or infectious diseases physician.

Results: : 8431 febrile episodes in infants 1-90 days were identified and 735 (8.7%) had SBI. The mean age of infants with SBI was 47 days (range 3-90 days). SBI included UTI (75%), bacteremia (14%), bacteremia and UTI (8%), meningitis (2%), bacteremia and meningitis (1%), and meningitis and UTI (<1%). SBI was due to Gram-negative pathogens in 615 (81%) episodes, including 91% of UTI, 48% of bacteremia, and 46% of meningitis. Escherichia coli was the most common pathogen overall and the most common cause of bacteremia, meningitis, and UTI.  Gram positive pathogens were identified in 120 episodes (19%). Group B Streptococcus was the most common Gram-positive pathogen (7%) followed by Enterococcus spp. (6%), methicillin-susceptible Staphylococcus aureus (2%) and Streptococcus pneumoniae (2%).  The CPM recommended antibiotics provided appropriate coverage for 99% of SBI in 1 to 90 day infants with suspected meningitis. For infants with UTI or no focus identified, coverage was 98% for </= 28 days and 91%, and 29 days and older, respectively.

Conclusion: 

The majority of SBI episodes in febrile infants 1-90 days are due to Gram-negative pathogens. E. coli is the most important cause of bacteremia, meningitis, and UTI in this age group. Antibiotic recommendations standardized through a CPM provided excellent coverage for pathogens responsible for SBI in young infants. Recommendations for antibiotic treatment based on regional surveillance may improve outcomes for febrile infants.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

E. Kent Korgenski, MS1, Adam L. Hersh, MD, PhD2, Emily A. Thorell, MD2, Karen Valentine, MS3, Carolyn Reynolds, MS, APRN3 and Carrie L. Byington, MD2, (1)Department of Pediatrics, Pediatric Clinical Program, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City, UT, (2)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (3)Intermountain Healthcare, Salt Lake City, UT

Disclosures:

E. K. Korgenski, None

A. L. Hersh, None

E. A. Thorell, None

K. Valentine, None

C. Reynolds, None

C. L. Byington, Idaho Technology, Inc.: Collaborator, Licensing agreement or royalty and subcontract on NIH grant

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