1779. Central Line-Associated Bloodstream and Catheter-Associated Urinary Tract Infection Pathogen Distribution and Antimicrobial Resistance Phenotypes Reported to the National Healthcare Safety Network from Pediatric Units, 2011–2014
Session: Oral Abstract Session: Children Getting Sick from Healthcare Pediatric HAIs
Saturday, October 29, 2016: 10:30 AM
Room: 275-277

Background: Previous analyses of central-line associated bloodstream infection (CLABSI) data reported to CDC’s National Healthcare Safety Network (NHSN) indicate that antimicrobial resistance (AR) associated with these infections is lower in pediatric and neonatal intensive care units (PICUs and NICUs) compared to adult locations. However, AR patterns across other pediatric location types and for other healthcare-associated infection (HAI) types have not been reported previously.  We describe CLABSI and catheter-associated urinary tract infection (CAUTI) AR patterns in several pediatric locations. 

Methods: We analyzed 2011-2014 data reported to NHSN from inpatient pediatric locations for CLABSI (NICU, PICU, oncology, ward locations) and CAUTI (PICUs and wards), stratifying by location type.  The proportion resistant (R) and nonsusceptible (NS) was calculated for 22 different pathogen-susceptibility phenotypes from available AR data including (depending on pathogen) vancomycin (VANC-R) and extended-spectrum cephalosporins (ESC-NS). Chi-squared and Fisher’s exact tests were used to compare %R and %NS between unit types.

Results: Pathogen distribution by location and HAI type are shown in the table. AR for many CLABSI pathogens was significantly lower in NICUs compared to other locations, though similar between the three non-NICU location types, e.g., the %ESC-NS for Klebsiella pneumoniae/oxytoca CLABSI was 4.9% (NICU), 15.8% (PICU), 16.5% (oncology), and 12.1% (ward) (NICU vs non-NICU, P<0.0001; P=0.33 across non-NICU locations); and for Pseudomonas aeruginosa CLABSI %ESC-NS was 11.5% (NICU), 20.7% (PICU), 15.5% (oncology), and 29.3% (ward) (NICU vs non-NICU, P=0.008; P=0.10 across non-NICU locations). Among CAUTI pathogens, %VANC-R Enterococcus faecalis was 15.2% (wards) vs 1.0% (PICUs) (P=0.006).  The %ESC-NS for P. aeruginosa CAUTI was higher in wards (22.2%) than PICUs (13.9%), although not statistically significant (P=0.19).

Conclusion: Pediatric CLABSI and CAUTI AR differ between unit types for some pathogens, suggesting a need for unit-specific infection control and antimicrobial stewardship strategies. With expanding reporting requirements, increased reporting from pediatric locations may improve the ability to detect AR differences for many pathogens and enhance the value of NHSN data for monitoring national trends.

 

Jason Lake, MD, MPH, Lindsey M. Weiner, MPH, Shelley S. Magill, MD, PhD and Isaac See, MD, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

J. Lake, None

L. M. Weiner, None

S. S. Magill, None

I. See, None

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