300. Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States
Session: Poster Abstract Session: HAIs in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • IDWeek Poster - Adams, Daniel.pdf (280.3 kB)
  • Background: Vancomycin-resistant Enterococcus (VRE) is an emerging drug-resistant organism responsible for increasing numbers of nosocomial infections in adults. Few data are available on the epidemiology of VRE infections in hospitalized children.

    Methods: A retrospective cohort study and trend analysis was performed utilizing data on hospitalizations for VRE infection from the 1997, 2000, 2003, 2006 and 2009 Healthcare Cost and Utilization Project Kids’ Inpatient Database. To establish which associated conditions are risk factors for VRE, the top 456 co-morbid ICD9-CM diagnosis and procedural codes among patients with a diagnosis of VRE were evaluated in a multivariable logistic regression model. A high-dimensional propensity score 1:10 case-control match was used to evaluate severity outcomes associated with VRE infection such as death, sepsis, length of stay, and hospitalization costs and charges.

    Results: Hospitalizations for VRE infection showed an increasing trend, from 365 hospitalizations in 1997 to 1123 in 2009 (P<0.0001), an average annual increase of 17.3%. Comorbid conditions associated with VRE infection included Clostridium difficile infection (CDI) (adjusted odds ratio [AOR], 1.94; 95% confidence interval [CI], 1.35-2.81), as well as other diagnoses associated with immunosuppression and antibiotic exposure. After adjusting for severity, patients with VRE infection had a significantly longer length of hospital stay (AOR, 1.20; 95% CI, 1.14-1.26), higher hospitalization charges (adjusted OR, 1.14; 95% CI, 1.08-1.20), higher hospitalization costs (AOR, 1.07; 95% CI, 1.01-1.14), and were more likely to have sepsis (AOR, 2.26; 95% CI, 1.79-2.84). VRE infection however was not associated with an increased risk of death (AOR, 0.99; 95% CI 0.70-1.39).

    Conclusion: The incidence of VRE infection among hospitalized children is increasing at a substantial rate. VRE infection was associated with conditions that cause immunosuppression, and involve invasive procedures and antibiotic administration. VRE has a significant impact on the health of hospitalized pediatric patients, including a higher risk of sepsis, and longer hospital stays. This study highlights the importance of strict adherence to existing infection control policies and the need for VRE surveillance in certain high-risk pediatric populations.

    Daniel Adams, MD1, Matthew Eberly, MD1, Anthony Goudie, PhD2 and Cade Nylund, MD1, (1)Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, (2)Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR


    D. Adams, None

    M. Eberly, None

    A. Goudie, None

    C. Nylund, None

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