1740. Klebsiella pneumoniae carbapenemase (KPC) producing Enterobacteriaceae infections in children: A two-center study
Session: Poster Abstract Session: Outbreaks of Bad Bugs and Prevention in Children
Saturday, October 10, 2015
Room: Poster Hall
Background: KPC-producing Enterobacteriaceae are multidrug-resistant organisms (MDROs) that cause major morbidity and mortality worldwide.  The epidemiology of KPC infections in U.S. children is understudied and available data are limited primarily to single center studies or outbreaks.  We sought to identify factors associated with KPC infections in children hospitalized in two tertiary care medical centers in Chicago, IL, 2008 – 2014.

Methods: We conducted a retrospective case-control study in patients aged 0 - 22 years.  Cases were defined as patients with infections phenotypically identified as KPC.  Controls were patients during the same time period with carbapenem susceptible Enterobacteriaceae infections. Cases and controls were 1:1 matched by age. Chi-squared analysis was performed.

Results: We identified 18 KPC-producing Enterobacteriaceae infections. The median patient age was 16.8 years, 33% were African-American, 67% were in an ICU setting, and 27% were residents of long-term care facilities.  The predominant organism was Klebsiella pneumoniae (77%), and the most common sources were blood (33%) and respiratory tract (27%); 56% of infections occurred >72 hours after hospital admission.  Compared to controls, cases were significantly more likely to have >3 comorbidities (83% vs. 17%, p<0.0001), especially gastrointestinal (77% vs. 39%, p<0.02) or hematologic-oncologic (72% vs. 33%, p<0.02). Cases were more likely to be ventilated (73% vs. 11%, p<0.05) and have had >1 MDRO infection (61% vs. 22%, p<0.02).   Cases and controls had similar (P=NS) high rates of invasive medical device use (88% vs. 83%), antibiotic receipt <40 days before infection (77% vs. 72%), and long length of stay (43.1 vs. 31.6 days). The mortality in cases was 23% vs. 12% in controls; however, most deaths were not due directly to infection. 

Conclusion: Potential factors associated with KPC-producing Enterobacteriaceae infections in children include ventilated status, recurrent MDRO infection, and chronic comorbidities, in particular gastrointestinal, hematologic-oncologic, or multiple conditions.  These findings may help target studies to prevent KPC infections in vulnerable children.

Felicia Scaggs, MD1, Angella Charnot-Katsikas, MD2, Allison H. Bartlett, MD, MS3, Xiaotian Zheng, MD, PhD4,5, Anand Karadkhele, MD, MPH6, Robert a. Weinstein, MD, FIDSA, FSHEA7,8,9 and Latania K. Logan, MD9,10, (1)Pediatrics, Rush University Medical Center, Chicago, IL, (2)Pathology, The University of Chicago Medicine, Chicago, IL, (3)Department of Pediatrics, Section of Infectious Diseases, University of Chicago Medicine, Chicago, IL, (4)Microbiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, (5)Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, (6)Rush University Medical Center, Chicago, IL, (7)Internal Medicine, Section of Infectious Diseases, Cook County Health and Hospitals System, Chicago, IL, (8)Internal Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, IL, (9)Rush Medical College, Chicago, IL, (10)Pediatrics, Section of Infectious Diseases, Rush University Medical Center, Chicago, IL

Disclosures:

F. Scaggs, None

A. Charnot-Katsikas, None

A. H. Bartlett, None

X. Zheng, None

A. Karadkhele, None

R. A. Weinstein, None

L. K. Logan, None

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