297. Epidemiology of Pediatric Healthcare-Associated Infections and Antimicrobial Use in U.S. Acute Care Hospitals
Session: Poster Abstract Session: HAIs in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 297_IDWEEK_3.pdf (564.4 kB)
  • Background: Healthcare-associated infection (HAI) surveillance in the United States has focused on acute care adult patients. Understanding HAI and antimicrobial use (AU) epidemiology in children will inform surveillance, prevention, and stewardship efforts.

    Methods: In 2011, 183 hospitals in CDC’s Emerging Infections Program (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN) conducted 1-day HAI and AU prevalence surveys on randomly-selected acute care patients. Medical records of patients on antimicrobial drugs (ADs) were reviewed to detect HAIs using National Healthcare Safety Network definitions. ADs were considered unique based on generic substance name; parenteral and oral vancomycin were considered distinct agents. Differences in HAI and AU prevalence and distribution between children (< 18 years) and adults were evaluated using SAS 9.3 and OpenEpi 3.0.

    Results: Among 11,282 patients, 1630 were children (median age 22 days; interquartile range 2 days-2 years).  59 HAIs occurred in 55 children for a prevalence of 3.4% (95% confidence interval [CI] 2.6-4.3%), compared to 4.1% (95% CI 3.7-4.5%) in adults (p=0.16). A total of 500 children (30.7%, 95% CI 28.5-33.0%) received ADs on the survey date or the day prior, compared to 5135 adults (53.2%, 95% CI 52.2-54.2%, p<0.001). Of 663 ADs given to children for active infections, 47% were for healthcare onset (HO) infections, compared to 27% in adults (p<0.001). Of 312 ADs for HO infections, 42% (131/312) were for suspected infections; 53% (69/131) of these were given to children >3 days old. The most prevalent HAIs and ADs in children compared to adults are presented in the table.

    Conclusion: The epidemiology of acute care HAIs and AU in children is different than in adults. More data are needed to understand HAIs and reasons for empiric AU in children. Future surveys should increase pediatric patient inclusion to guide surveillance and prevention. 

    Table

     

    HAIs

     

     

    Active Infection ADs

    Rank

    Pediatric (%)  N=59

    Adult (%)

    N=445

     

    Pediatric, age ≤90 days (%)

    N=284

    Pediatric, age >90 days (%)

    N=379

    Adult (%)

    N=6961

    1

    PNEU (18.6)

    SSI (23.4)

     

    Ampicillin (29.9)

    Vancomycin IV (12.9)

    Vancomycin IV (14.7)

    2

    BSI (15.3)

    PNEU (22.3)

     

    Gentamicin (23.2)

    Clindamycin (7.9)

    Ceftriaxone (11.4)

    3

    UTI (13.6)

    GI (18.2)

     

    Cefotaxime (12.3)

    Ceftriaxone (6.3)

    Piperacillin/tazobactam (10.9)

    Susan N. Hocevar, MD1, Scott Fridkin, MD1, Jonathan R. Edwards, MStat1, Joelle Nadle, MPH2, Sarah Jackson Janelle, MPH3, Richard Rodriguez, MPH4, Susan M. Ray, MD5, Katherine Richards, MPH6, Ruth Lynfield, MD7, Deborah Thompson, MD, MSPh8, Ghinwa Dumyati, MD, FSHEA9, Zintars G. Beldavs, MS10, Marion a. Kainer, MBBS, MPH11 and Shelley S. Magill, MD, PhD1, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)California Emerging Infections Program, Oakland, CA, (3)Colorado Department of Public Health and Environment, Denver, CO, (4)Connecticut Department of Public Health, Hartford, CT, (5)Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, (6)Maryland Department of Health and Mental Hygiene, Baltimore, MD, (7)Acute Disease Investigation and Control, Minnesota Department of Health, St. Paul, MN, (8)New Mexico Department of Health, Santa Fe, NM, (9)University of Rochester, Rochester, NY, (10)Oregon Department of Human Services, Portland, OR, (11)Tennessee Department of Health, Nashville, TN

    Disclosures:

    S. N. Hocevar, None

    S. Fridkin, None

    J. R. Edwards, None

    J. Nadle, None

    S. Jackson Janelle, None

    R. Rodriguez, None

    S. M. Ray, None

    K. Richards, None

    R. Lynfield, None

    D. Thompson, None

    G. Dumyati, None

    Z. G. Beldavs, None

    M. A. Kainer, None

    S. S. Magill, None

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