Program Schedule

371
Outcomes of Enterobacter bloodstream infection in hospitalized children

Session: Poster Abstract Session: Pediatric Antimicrobial Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Outcomes of Enterobacter bloodstream infection in hospitalized children

Background: Enterobacter spp. has emerged as a major cause of nosocomial infections in children and adults, and may carry chromosomal AmpC β-lactamases that limits the choice of appropriate antibiotics. The antimicrobial treatment strategies for and outcomes of Enterobacter bacteremia in children have not been well described.

Methods: Multicenter, retrospective cohort study of patients ˛18 years admitted with monomicrobial Enterobacter spp. bloodstream infection at The Children's Hospital of Philadelphia, Johns Hopkins Children's Medical Center and Mayo Clinic Children's Hospital. Comprehensive chart review was performed to collect clinical and demographic data on all patients. Antibacterial exposure was recorded daily for 30 days and classified by antimicrobial class and whether combination therapy was used. Descriptive analysis included medians for continuous variables and percentages for categorical data.

Results: From Jan 2002 - Dec 2012, 471 episodes of bacteremia occurred in 411 children [Median age: 1.3 yr (IQR: 0.3 – 6.6), male 64%]. Most children had multiple comorbid conditions and outcomes varied by treatment regimen (Table).

Baseline characteristics

³3 comorbid medical conditions

88%

Presence of immunosuppression

38%

Surgery 1 week prior

20%

Presence of central catheter

82%

Other concomitant infection

26%

ID consultation during first 15 days

41%

Catheter removal

60%

Clinical outcomes by definitive therapy grouping (includes 92% of total episodes)

Total

3rd cephalosp

Cefepime

Carbapenem

β-lactam inh

Quinilone

Mono

7%

Com*

18%

Mono

18%

Com*

9%

Mon

10%

Com*

13%

Mon

3%

Com*

7%

Mono

7%

Com*

2%

Clinical worsening¤

14%

9%

17%

12%

12%

15%

19%

17%

12%

16%

12%

Relapse¦

5%

9%

4%

1%

2%

7%

8%

17%

3%

3%

12%

30-day mortality

7%

12%

7%

7%

10%

11%

3%

-

3%

3%

-

¤New requirement of ventilatory support, vasopressors, intensive care admission or relapse of fever during the first 15 days

¦Isolation of Enterobacter spp. 7 days after onset of bacteremia having documented prior clearance

* Combination therapy including an aminoglycoside or quinolone plus the main grouping agent

Conclusion: Enterobacter bacteremia is a severe infection in children. Future studies will compare outcomes by antimicrobial treatment regimen.

Beatriz Larru, MD, PhD1, Neika Vendetti, MPH1, Pranita D. Tamma, MD, MHS2, Ritu Bannerjee, MD, PhD3, Theresa Madigan, MD3, Russell Localio, PhD4, Theoklis Zaoutis, MD, MSCE1,5 and Jeffrey S. Gerber, MD, PhD6,7, (1)Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, the Children's Hospital of Philadelphia, Philadelphia, PA, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Department of Pediatrics, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, (3)Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, MN, (4)Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, (5)Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, (6)Division of Pediatric Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hsopital of Philaldephia, Philaldephia, PA, (7)University of Pennsylvania School of Medicine, Philadelphia, PA

Disclosures:

B. Larru, None

N. Vendetti, None

P. D. Tamma, None

R. Bannerjee, None

T. Madigan, None

R. Localio, None

T. Zaoutis, Merck: Investigator, Research grant
Merck: Consultant, Consulting fee
Pfizer: Consultant, Consulting fee
Astellas: Consultant, Consulting fee

J. S. Gerber, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

Sponsoring Societies:

© 2014, idweek.org. All Rights Reserved.

Follow IDWeek