1257. Does monthly palivizumab prevent nosocomial Respiratory Syncytial Virus (RSV) in high-risk infants in Newborn Intensive Care (NICU)?
Session: Oral Abstract Session: Respiratory Viral Infections in Children
Saturday, October 5, 2013: 10:45 AM
Room: The Moscone Center: 200-212
Background: Nosocomial outbreaks of RSV have occurred in NICUs, but an American Academy of Pediatrics (AAP) evidence-based policy statement concluded that strict infection control practices can decrease nosocomial RSV and evidence does not support the use of palivizumab in hospitalized pre-term neonates until discharge. From 2009-2011, monthly palivizumab was prescribed to many high-risk infants in the Primary Children’s Medical Center (PCMC) NICU seasonally according to local epidemiology. The practice was changed in 2011 and single dose palivizumab was given within 48-72 hours of discharge. The objective of this study was to document the occurrence of nosocomial RSV in high-risk infants when palivizumab was administered monthly in conjunction with infection control interventions (P-ICI; 2009-2011) compared with a period that included ICI (2012-2103) only.

Methods: The Intermountain Enterprise Data Warehouse (EDW) was queried to identify NICU patients at PCMC from 11/09 through 4/13. Each RSV season was defined as 11/1 through 4/30. We evaluated palivizumab use, RSV testing, and nosocomial RSV in NICU patients during each season and compared the P-ICI period with the ICI period.

Results: The incidence of nosocomial RSV was 4.1/10,000 patient-days (95% CI 2.0-7/10,000) in the P-ICI period compared with 0/10,000 patient-days (95% CI 0-1.8/10,000; P = 0.013) in the ICI period. Testing practices and patient characteristics did not change (Table). Total use of palivizumab decreased by 54% (P <0.001) and wholesale acquisition costs (WAC) of palivizumab decreased  from $224,660 to $124,880.  

 

P-ICI

ICI

Total NICU Patients, N

597

539

Patient-Days

14,519

15,348

Infants receiving palivizumab, N (% total)

107 (17.9%)

78 (14.5%)

Total doses of palivizumab

174 (0.3/patient)

80 (0.15/patient)

NICU RSV tests

169

174

Nosocomial RSV Cases

6

0

Palivizumab WAC

$224,660

$124,880

Conclusion: Nosocomial RSV cases were rare in a NICU with strong ICI. The monthly use of palivizumab was not associated with decreased nosocomial RSV compared with ICI alone, but increased cost significantly.  These data support the 2012 AAP policy statement.

Jared Olson, PharmD1, Carrie L. Byington, MD2, Andrew Pavia, MD, FIDSA, FSHEA3, Roger Faix, MD4, Adam L. Hersh, MD, PhD3, Krow Ampofo, MD3 and Emily A. Thorell, MD, MSci3, (1)Primary Children's Medical Center, Salt Lake City, UT, (2)Pediatrics, University of Utah, Salt Lake City, UT, (3)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (4)University of Utah, Salt Lake City, UT

Disclosures:

J. Olson, None

C. L. Byington, BioFire Diagnostics: Collaborator and Grant Investigator, Grant recipient and Licensing agreement or royalty

A. Pavia, None

R. Faix, None

A. L. Hersh, None

K. Ampofo, None

E. A. Thorell, None

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