970. Pediatric and Source Specific Antibiograms: Do little bugs have big resistance?
Session: Poster Abstract Session: Stewardship: Epidemiology of Antibiotic Use
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • idsa poster UM LW 925 final.pdf (1.2 MB)
  • Background: Antimicrobial susceptibility patterns in pediatric and adult populations differ in common bacterial infections. Antimicrobial stewardship strategies emphasize that empiric antimicrobial therapy should be patient specific, guided by local data and the presumptive site of infection.  

    Methods: Retrospective review of the microbiology surveillance system (Vigilanz) was performed to identify unique pediatric isolates (first positive per patient over one year) at Holtz Children’s Hospital (254 beds, Miami, FL) from March 2012 to 2013. Pediatric specific antibiogram (ATB) was created and categorized by patient location (intensive care unit [ICU], non-ICU, emergency department [ED]) and source of positive culture (blood, urine, respiratory and other). Susceptibilities of the most frequent organisms (Escherichia coli, methicillin resistant Staphylococcus aureus [MRSA], Klebsiella pneumoniae, Pseudomonas aeruginosa and Streptococcus pneumoniae)were compared between the pediatric and hospital wide ATBs using Chi-square and Fisher exact test, with a Bonferroni adjustment.

    Results: 1033 unique patient isolates were analyzed: 58.6% ICU, 25% non-ICU and 16.3% ED.  Sources were: 46.3% respiratory, 22% urine, 8.3% blood and 23.3% others.  When comparing the pediatric data to the hospital-wide ATB, K.pneumoniae and E.coli were more susceptible to levofloxacin (97% vs. 87% p = 0.0018 and 87% vs. 66% <0.001), P. aeruginosa was more susceptible to cefepime (94% vs. 85%, p = 0.0343) and meropenem (93% vs. 73%, p = 0.0003) and MRSA was more susceptible to clindamycin (72% vs 60%, p = 0.0192).  For S. pneumoniae, pediatric isolates were less susceptible to penicillin (31% vs. 77%, p = 0.0005).  Also notable was in subgroup analysis, MRSA isolates from blood, urine and respiratory sources were less susceptible to clindamycin as compared with all other sources such as wound cultures (45% vs. 90%).

    Conclusion: Our study shows that hospital wide ATBs may not be completely generalizable to the pediatric population.  Developing pediatric specific ATBs with further analysis by source and unit, could guide more appropriate empiric antimicrobial therapy. Future efforts should include healthcare provider education to appropriately interpret these reports and effectively improve antimicrobial prescribing behaviors.

    Lena Wong, MD, Jackson Memorial Hospital, Miami, FL, Carlos Guerra-Sanchez, MD, Pediatrics, Division of Immunology and Infectious Diseases, University of Miami Miller School of Medicine/Jackson Health System, Miami, FL, Kaming Lo, MPH, Epidemiology and Public Health , University of Miami Miller School of Medicine, Miami, FL, Ivan Gonzalez, MD, Department of Pediatrics - Infectious Diseases, Univ. of Miami - Miller School of Medicine, Miami, FL and Lilian Abbo, MD, Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL

    Disclosures:

    L. Wong, None

    C. Guerra-Sanchez, None

    K. Lo, None

    I. Gonzalez, None

    L. Abbo, None

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