2341. Trends in Adenovirus Infections in Singapore Children and Outcomes of Cidofovir Treatment in the Severely Ill
Session: Poster Abstract Session: Pediatric Viral Infections
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • Trends in Adenovirus Infections in Singapore Children and Outcomes of Cidofovir Treatment in the Severely Ill.pdf (634.9 kB)
  • Background: An increase in human adenovirus (HAdV) infections among hospitalized children in Singapore was observed since 2013. Cidofovir is often used to treat severe HAdV infections despite limited data. This study describes the epidemiology and outcomes of children with severe HAdV disease requiring high dependency (HD) or intensive care unit (ICU) admission in our hospital (KKH).

    Methods: This is a retrospective cohort study of HAdV-infected children admitted to HD and ICU in KKH from January 2013 to September 2017. Characteristics and outcomes of those who received IV cidofovir was also reviewed.

    Results: HAdV admissions and genotype profiles in KKH are described in Figures 1 and 2 respectively. There were 85 children with severe HAdV infection, of which 17 (20%) received cidofovir for mainly viremia (8, 47.1%) and pneumonia (7, 41.2%). Of these 17 patients, 7 (41.2%) died. More children treated with cidofovir had genotype 7 infection (8 of 17, 47.1%) versus 13 of 68 (19.1%) who did not (p = 0.027).

    Characteristics of patients who received cidofovir are described in Table 1. None experienced adverse reactions from cidofovir.

    Table 1: Comparison of characteristics of 17 children who received IV cidofovir

    Discharged

    (N=10)

    Death

    (N=7)

    P value

    Age in years (median, IQR)

    2.6 (1.7 – 3.7)

    2.2 (1.2 – 5.9)

    0.922

    Male

    5 (50.0)

    6 (85.7)

    0.304

    Significant co-morbidities

    5 (50.0)

    6 (85.7)

    0.304

    Prematurity

    0 (0.0)

    1 (14.3)

    0.412

    Neurological

    1 (10.0)

    3 (42.9)

    0.250

    Cardiopulmonary

    0 (0.0)

    1 (14.3)

    0.412

    Immunodeficiency

    3 (30.0)

    1 (14.3)

    0.603

    Others

    1 (10.0)

    0 (0.0)

    1.000

    Disease presentation

    Pneumonia

    1 (10.0)

    6 (85.7)

    0.004

    Gastroenteritis

    1 (10.0)

    0 (0.0)

    1.000

    Neutropenic sepsis

    0 (0.0)

    1 (14.3)

    0.412

    Viremia

    8 (80.0)

    0 (0.0)

    0.002

    Days of symptoms prior admission (median, IQR)

    6.5 (2.3 – 10.8)

    4.0 (0.0 – 5.0)

    0.350

    Adenovirus genotype 7

    4 (40.0)

    4 (57.1)

    0.637

    Required ICU stay

    5 (50.0)

    7 (100.0)

    0.044

    Days to cidofovir (median, IQR)

    7.0 (1.5 – 25.8)

    12.0 (4.0 – 40.0)

    0.434

    Length of stay in days (median, IQR)

    21.5 (15.0 – 63.5)

    34.0 (16.0 – 43.0)

    0.696

    All are n (%) unless stated otherwise.

    Conclusion: More children with HAdV genotype 7 infection required cidofovir treatment. HAdV pneumonia and ICU admission are potential risk factors for mortality despite cidofovir treatment.

     

    Valerie Xue Fen Seah, BSc(Pharm)(Hons), PharmD1, Yirong Chew, .2, Koh Cheng Thoon, MBBS, MMed (Paeds), MRCPCH3, Nancy Wen Sim Tee, MBBS, FRCPA4, . Yelen, .3, Lin Cui, .5, Chia Yin Chong, MBBS, M. Med, FRCPCH3, Chee Fu Yung, MFPHM (UK), FFPHM (UK)3, Matthias Maiwald, MD, FRCPA6, Raymond Reinaldo Tanugroho, MBBS7 and Natalie Woon Hui Tan, MBBS, MRCPCH3, (1)Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore, (2)Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore, Singapore, (3)Infectious Disease Service, Department of Pediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore, (4)Microbiology, KK Women’s and Children’s Hospital, Singapore, Singapore, (5)National Public Health Laboratory, Singapore, Singapore, (6)Microbiology, KK Women's and Children's Hospital, Singapore, Singapore, (7)Pediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore

    Disclosures:

    V. X. F. Seah, None

    Y. Chew, None

    K. C. Thoon, None

    N. W. S. Tee, None

    Yelen, None

    L. Cui, None

    C. Y. Chong, None

    C. F. Yung, None

    M. Maiwald, None

    R. R. Tanugroho, None

    N. W. H. Tan, None

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