695. Risk factors for Invasive Acinetobacter Infections in Children: A Case – Control Study
Session: Poster Abstract Session: They've Been Here a Billion Years! Pediatric Bacterial and Viral Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Acineto Poster Kaur 36x60.pdf (771.8 kB)
  • Background: Acinetobacter infections in adults increasingly are nosocomial and multidrug resistant (MDR). Data in children are limited but suggest that Acinetobacter is emerging as a clinical pathogen. Invasive infections are relatively infrequent in children. We aimed to identify risk factors for invasion of Acinetobacter spp. in children. 

    Methods: Patients (pts) with invasive and noninvasive Acinetobacter infections were identified from Jan Ô08-Dec Õ15 by medical record review. Clinical & microbiologic data were analyzed by retrospective case-control design with multivariate analysis. Cases were patients with invasive infection (INV), defined by Acinetobacter isolation from sterile body sites, deep tissue, or in significant colony count in urine or bronchial lavage. Controls were pts with noninvasive infection (non-INV), defined by isolation of Acinetobacter from upper respiratory culture or superficial skin/wound culture taken for clinical suspicion of infection and gram stain performed. Isolates obtained as outpatient were excluded. In pts with >1 isolate of Acinetobacter, only the first clinical episode was used for analysis. MDR Acinetobacter was defined as resistance to at least ³1 agent in ³3 drug classes.

    Results: 50 pts with INV (29 blood, 10 urine, 3 CSF, 6 deep soft tissue, 2 BAL) and 146 pts with non-INV (88 upper respiratory, 58 superficial skin/wound) were included. Only one infection was health care associated (CLABSI). Acinetobacter baumannii was most frequent isolate (Fig 1). Antimicrobial susceptibility profiles were similar between cases and control isolates (Fig 2). Two isolates (non-INV) were carbapenem resistant. 11 isolates were MDR (7 INV, 4 non-INV). Majority pts had predisposing factors (Fig 3); only 10% with INV had no identifiable risk factors. Multivariate analysis with logistic regression identified risk factors for INV: age ³10 years {p=0.004; OR 3.2 [CI 1.44-7.01]} and hospitalization within prior 60 days {p=0.024; OR 2.7 [CI 1.1 to 6.5]}. Presence of >1 pathogen in clinical specimen was associated with decreased risk of INV {p=0.002; OR 0.32 [CI 0.16 to 0.67]}.

    Conclusion: Age ³10 years and hospitalizations in prior 60 days were independent predictors of invasive Acinetobacter infection.

     

     

    Ishminder Kaur, M.D.1, Jennifer Vodzak, MD1, Jeffrey Yaeger, MD, MPH2, Alan T. Evangelista, PhD3, Sarah S. Long, MD4 and Jane M. Gould, MD5, (1)Infectious Diseases, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, (2)Hospital Medicine, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, (3)Microbiology, Virology and Molecular Diagnostics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, (4)St. Christopher's Hospital for Children, Philadelphia, PA, (5)Infectious Diseases and Infection Prevention, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA

    Disclosures:

    I. Kaur, None

    J. Vodzak, None

    J. Yaeger, None

    A. T. Evangelista, None

    S. S. Long, None

    J. M. Gould, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.