698. Risk factors and outcomes for children with carbapenem-resistant Enterobacteriaceae: a multicenter case series
Session: Poster Abstract Session: They've Been Here a Billion Years! Pediatric Bacterial and Viral Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • CRE IDWeek 2016.pdf (125.8 kB)
  • Background: Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly identified causes of healthcare-associated infections in adults, but little is known about CRE in children.

    Methods: Patients <21 years admitted to The ChildrenÕs Hospital of Philadelphia, JohnÕs Hopkins Hospital, or Boston ChildrenÕs Hospital with CRE isolated from clinical cultures between 2011 and 2015 were included. Data were obtained by medical record review and analyzed using descriptive statistics.

    Results: Sixty-two unique patients with CRE were identified. Enterobacter species were isolated most often, followed by Klebsiella species. Approximately half of isolates were tested for carbapenemase production and 61% were positive (Figure 1). Patient characteristics are shown in Table 1. Prior hospitalization (n=31; 50%) and medical care abroad (n=10; 16%) were common. Rates of recent broad-spectrum antibiotic use, including carbapenems (n=23; 37%), were high. Combination therapy was prescribed infrequently and 60-day mortality was 11% (Table 2).

    Conclusion: Our study identifies several important risk factors for CRE in children and highlights key differences from adult patients, including a predominance of Enterobacter species, infrequent use of dual therapy, and substantially lower mortality.

    Figure 1. Microbiology (n=62)

    a. Organism

    Title: n=62

    b. Source

     

    c. Carbapenemase testing

    Table 1. Baseline clinical and demographic variables

    Variable

    n=62

    Median age, months (IQR)

    24 (5, 144)

    Male

    44 (71)

    Recent acute care admission

    31 (50)

    Median LOS, days (IQR)

    41 (16, 85)

    Transfer from outside facility

    15 (24)

    Long-term care facility resident

    3 (5)

    International healthcare

    10 (16)

       United Arab Emirates

    3 (30)

       India

    1 (10)

       Kuwait

    4 (40)

       Pakistan

    1 (10)

       Saudi Arabia

    1 (10)

    ICU admission

    37 (60)

    Comorbidities

        Hematopoietic stem cell transplant

    1 (2)

        Solid organ transplant

    7 (11)

        Malignancy

    8 (13)

        Congenital heart disease

    6 (10)

        Prematurity

    11 (18)

        Renal/urologic

    13 (21)

    Devices

        Central line

    38 (61)

        Tracheostomy

    9 (15)

        Endotracheal tube

    20 (32)

        Urinary Catheter

    11 (18)

    Recent surgery

    40 (65)

    Anti-pseudomonal exposure

    44 (71)

    Carbapenem exposure

    23 (37)

    Table 2. Treatment and outcomes for patients with CRE infection

    Variable

    n=27

    Combination antibiotic therapy

    5 (19)

    60-day attributable mortality

    3 (11)

    Recurrent Infection

    5 (19)

    Kathleen Chiotos, MD1, Pranita D. Tamma, MD, MHS2, Kelly B. Flett, MD, MMSc3, Manjiree V. Karandikar, MD3, Adam Hirsh, BS2, Theoklis Zaoutis, MD, MSCE1, Lauren Farrell, MS, MLS(ASCP), CIC1 and Jennifer Han, MD, MSCE4, (1)The Children's Hospital of Philadelphia, Philadelphia, PA, (2)The Johns Hopkins University School of Medicine, Baltimore, MD, (3)Boston Children's Hospital, Boston, MA, (4)Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

    Disclosures:

    K. Chiotos, None

    P. D. Tamma, None

    K. B. Flett, None

    M. V. Karandikar, None

    A. Hirsh, None

    T. Zaoutis, None

    L. Farrell, None

    J. Han, 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.