2302. Bloodstream Infections due to Carbapenem Resistant Gram-Negative Bacteria in Pediatric Intensive Care Unit (PICU): Risk Factors and Outcomes
Session: Poster Abstract Session: Pediatric Healthcare Associated Infections
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • poster IDWEEK 2018.pdf (705.0 kB)
  • Background: Bloodstream infections (BSI) caused by multidrug-resistant bacteria are associated with poor outcome and increased cost. We investigated risk factors for carbapenem resistance (CR) and outcome associated with the development of BSI due to Gram-negative (GN) bacteria in PICU patients, a very vulnerable population.

    Methods: We reviewed the records of 1mo - 15yr old patients with documented GN BSI hospitalized in a PICU from 2005-2017. Isolates with meropenem MIC ≥16 mg/l were considered as resistant. Demographics, clinical characteristics, potential risk factors for acquisition of resistant strains, treatment, potential source control and outcome were recorded. Outcome was determined as microbiological response (negative blood cultures) within 5d and mortality within 30d. Both univariate and multivariable logistic regression analysis was performed and odds ratios (OR) with 95% confidence intervals (CI) were presented.

    Results: 81 patients with GN BSI were studied (34.6% Pseudomonas aeruginosa, 34.6% Acinetobacter baumannii and 30.9% Enterobacteriaceae), 21 with CR isolates. Risk factors for CR BSI were: prior carbapenem use (OR: 3.86, 95%CI: 1.10, 13.82) and renal replacement therapy (OR: 3.86, 95%CI: 1.10, 13.82). In multivariable outcome analysis, high levels of CRP (OR: 0.99, 95%CI: 0.99, 0.999), renal replacement therapy (OR: 0.11, 95%CI: 0.01, 0.71) and inotrope administration (OR: 0.30, 95%CI: 0.09, 0.91) were associated with poor microbiological response, whereas source control (OR: 2.99, 95%CI: 1.01, 9.43) with better microbiological response. High PRISM score III (OR: 1.15, 95%CI: 1.04, 1.29) and CR (OR: 5.07, 95%CI: 1.47, 19.36) were both independently associated with worse outcome, whereas source control was the only independent factor preventing death (OR: 0.24, 95%CI: 0.06, 0.78). In patients with CR BSI, administration of at least two active antimicrobials was associated with better outcome (OR: 10.80, 95%CI: 1.33, 237.05).

    Conclusion: Prior carbapenem use is associated with carbapenem-resistant BSI development in PICU, which in turn is an independent risk factor for mortality. Source control is associated with better microbiological response within 5d, as well as with decreased mortality.

    Violetta-Magdalini Darda, MD1, Elias Iosifidis, MD, PhD1, Eleni Volakli, MD, PhD2, Charalampos Antachopoulos, MD, PhD3, Anna-Bettina Haidich, PhD, MSc1, Eleni Vagdatli, MD, PhD2, Maria Sdougka, MD, PhD2 and Emmanuel Roilides, MD, PhD, FIDSA3, (1)Aristotle University of Thessaloniki, Thessaloniki, Greece, (2)Hippokration Hospital of Thessaloniki, Thessaloniki, Greece, (3)3rd Dept of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Disclosures:

    V. M. Darda, None

    E. Iosifidis, None

    E. Volakli, None

    C. Antachopoulos, None

    A. B. Haidich, None

    E. Vagdatli, None

    M. Sdougka, None

    E. Roilides, None

    Previous Abstract | Next Abstract >>

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.