bluuebunny/crossref_metadata_2025 huggingface dataset:
1656. Evaluation of Using Oxacillin versus Vancomycin for Empiric Therapy of Late-Onset Neonatal Sepsis in NICU
Authors: Lien Tsung-Chi , Husted Harlan , Taha Sahar , Ip Alice , Covarrubias Laurie , Henschel Kathleen , Mendoza Maria Concepcion , Rajani Anand , Rongkavilit Chokechai
Published: November 2023

Background

Our Pediatric Antimicrobial Stewardship Program (PedASP) assessed methicillin-sensitive (MSSA) and methicillin-resistant S. aureus (MRSA) infections in neonatal intensive care unit (NICU) and created a NICU-specific antibiogram. Due to a rising trend of NICU MSSA infections seen in our 84-bed NICU, empiric therapy of late-onset neonatal sepsis (LONS) was modified from vancomycin to oxacillin in January 2021. We report the two-year results of using empiric oxacillin for LONS.Figure 1.Summary of S. aureus identified in LONS cases

Methods

We assessed MSSA versus MRSA isolated from blood and non-blood cultures in NICU between January 2019 and December 2022. Infants with weight less than 750 grams, previous MRSA infections, maternal MRSA colonization, or serious infections based on clinical judgement were advised to use empiric vancomycin. We examined the vancomycin eligibility criteria, antibiotic-pathogen mismatch rate, 30-day mortality, and frequency of peripheral intravenous (PIV) access loss after vancomycin or oxacillin administration. The cost-savings was estimated by comparing drug and lab costs associated with vancomycin and oxacillin use.

Results

LONS cases are summarized in Figure 1. There was no statistical difference in incidence of S. aureus bacteremia before and after protocol implementation (p=0.45). Antibiotic-pathogen mismatch rate was 0%. Cases of MRSA bacteremia increased from 0 to 3 post protocol initiation; all cases met vancomycin eligibility criteria. The 30-day mortality among MRSA infections increased from 0 to 1 case. Post protocol implementation, the PIV loss rate decreased from 4.7 to 3.3% (p=0.04), and vancomycin use decreased by 1154 doses while oxacillin use increased by 485 doses. Based on antibiotic use and 141 vancomycin levels averted, the estimated cost-savings was $140,229.

Conclusion

Our PedASP utilized local susceptibility data to change empiric antibiotics for LONS, reinforcing the benefit of using antibiogram to optimize antibiotic use in NICU. Implementing a NICU-specific antibiogram improved the effectiveness of antibiotic treatment and achieved significant cost savings.

Disclosures

All Authors: No reported disclosures
1658. Rational use strategy for clarithromycin in a pediatric hospital: is it used more than is required?
Authors: Londono-Ruiz Juan Pablo , Lombo Julian Enrique Avila , Losada Maria Alejandra Medina , Gutierrez-Tobar Ivan Felipe , Rodriguez-hernandez Andrea Esperanza
Published: November 2023

Background

Clarithromycin is a macrolide used to treat microorganisms that cause atypical pneumonia or whooping cough in pediatrics. Studies have shown that its use in typical pneumonia does not change clinical outcomes. The implementation of an Antimicrobial Stewardship (ASP) strategy directed at this antibiotic and its rational use allows for reductions in its unnecessary consumption. The aim of this work is to show the impact of an antibiotic control intervention on the use of clarithromycin in a pediatric hospital.

Methods

A before-and-after study was carried out in between 2018 and 2022. In 2020 begins the intervention period during which several educational measures aimed at the clarithromycin formulation were implemented, including a virtual training space, a graphic piece for knowledge of the tools, and the implementation of an audit and feedback system for all clarithromycin formulations. Special emphasis was placed on the differential diagnosis of atypical pneumonia caused by viruses and the promotion of the oral route for this antibiotic. Antibiotic consumption was measured using Days of Therapy (DOT) and adherence to local prescription guidelines. R (version 4.2.2) was used for statistical analysis.

Results

Two years prior to the intervention (2018 and 2019) were analyzed, 2020 was taken as the washout year, and two years after the intervention (2021 and 2022) were analyzed. The average DOT in the pre-intervention period was 10 DOT x 1,000 hospital discharges, compared to the post-intervention period where it was 0.8 DOT x 1,000 hospital discharges (p value < 0.001). In the pre-intervention years, a peak in formulation related to the respiratory peak was observed (between March and May) (Figure 1). Adherence to local prescription guidelines increased from 60% to 95% in the post-intervention period (p value < 0.05).

Days of Therapy (DOT) x 1.000 hospital beds between 2018 and 2022. A decrease in the consumption of antibiotics is shown after the implementation of ASP strategy in February 2020

Conclusion

The use of the tools of an antibiotic control program aimed at the use of clarithromycin showed a decrease in the consumption of this antibiotic and increased adherence to the prescription guidelines. It is possible that, on many occasions, the formulation of this was unnecessary.

Disclosures

All Authors: No reported disclosures
1662. Perspectives of Caregivers of Children with Community-Acquired Pneumonia in the Emergency Department: A Qualitative Study
Authors: Murphy Lara , Huang Nelson , Kandasamy Sujane , Wahi Gita , Pernica Jeffrey
Published: November 2023

Background

Despite the fact that paediatric community-acquired pneumonia (CAP) is usually caused by viruses, antibiotics are often prescribed. The objective of this study was to understand caregiver perspectives and experiences relating to the treatment of paediatric CAP.

Methods

This was a phenomenologically-informed qualitative study involving interviews with caregivers of young children in Hamilton, Ontario. Caregivers were interviewed with open-ended questions relating to germ theory, the nature of pneumonia, and the role of antibiotic treatment. The principles of conventional content analysis were used to guide the coding and synthesis of the transcribed interviews.

Results

Eleven caregivers were interviewed. Most had a good understanding of the difference between bacteria and viruses and many knew that antibiotics were not effective against all types of infections. Many also stated that there was an increased risk of developing resistance with frequent antibiotic use. However, there were misconceptions that probiotics effectively mitigated antibiotic side effects and few were familiar with the potential long-term impacts of antibiotic use in children. There was variability in the perceived severity of paediatric CAP. For children sick enough to require treatment in the emergency department (ED), some participants thought that antibiotic treatment would be important to prescribe to accelerate recovery, as well as to prevent caregivers from feeling helpless. However, participants also thought it was inappropriate for physicians to prescribe antibiotics solely to make the caregiver feel better. Many caregivers also felt strongly that clinical follow-up and discussions on treatment risks and benefits would be desirable and might counteract feelings of helplessness that might result from being sent home without a prescription.

Conclusion

Recognizing that parents may have misperceptions about antibiotic use for CAP (and may seek antibiotics without strong rationale) can inform clinicians’ efforts to better educate and support caregivers in the ED. Care strategies informed by caregiver experiences can improve parent-provider communication, increase trust in the attending clinician, and reduce antibiotic misuse.

Disclosures

Jeffrey Pernica, MD, MSc, FRCPC, DTMH, MedImmune: Grant/Research Support|Merck: Grant/Research Support
1664. The Impact of Levofloxacin Prophylaxis on Empiric Intravenous Antibiotic Use in Pediatric Hematopoietic Stem Cell Transplant Recipients
Authors: Prodanuk Michael , Timberlake Kathryn E , Koo Alicia , Chopra Yogi , Wall Donna , Science Michelle
Published: November 2023

Background

Clinical trials have demonstrated that levofloxacin prophylaxis during periods of neutropenia in hematopoietic stem cell transplantation (HSCT) reduces the frequency of bacteremia in adults and febrile episodes in children. Therefore, levofloxacin prophylaxis may also have a role in reducing empiric intravenous antibiotic (EIA) use.

Methods

This retrospective review assessed the impact of levofloxacin prophylaxis for patients < 18 years undergoing HSCT at a Canadian children’s hospital. The primary outcome was antibiotic days of therapy (DOT) during the pre-engraftment period comparing the pre-levofloxacin era (Jan 1, 2019–Jun 30, 2020) to the levofloxacin era (Jul 1, 2020–Dec 31, 2021). Patients were excluded if they were receiving EIA at the time of transplant, received chimeric antigen receptor T-cell therapy, or if levofloxacin use was discordant with their era. Secondary outcomes included the number of positive blood cultures and clinical deterioration episodes (clinical change resulting in blood culture draw and initiation/change of EIA).

Results

Fifty-four of 152 patients (36.5%) and 55 of 147 patients (37.4%) were included in the pre-levofloxacin and levofloxacin eras respectively. The most common reasons for exclusion were EIA use at the time of transplant and levofloxacin use discordant with the patient's era (Figure 1). Baseline characteristics were not significantly different between groups (Table 1). Mean DOT/pre-engraftment days (%) were significantly lower in the levofloxacin era for piperacillin-tazobactam (53.3 vs. 38.3, p=0.004) and amikacin (1.7 vs. 0.1, p=0.03), while there was no significant difference for meropenem, vancomycin, or all other antibiotics combined. There was also no significant difference in the number of positive blood cultures (11 vs. 7, p=0.35) or clinical deterioration episodes (55 vs. 66, p=0.1).

Conclusion

Levofloxacin prophylaxis in children undergoing HSCT reduced percent pre-engraftment days on piperacillin-tazobactam and amikacin, with no significant impact on the number of positive blood cultures or clinical deterioration episodes. Therefore, levofloxacin prophylaxis may facilitate antimicrobial stewardship activities through reduced use of certain broad-spectrum antibiotics.

Disclosures

Kathryn E. Timberlake, PharmD, Avir Pharma: Advisor/Consultant
1669. Impact of Required Durations of Therapy for Antibiotic Orders at the Time of Order Entry
Authors: Wright Megan R , Gillon Jessica , Katz Sophie E , Banerjee Ritu
Published: November 2023

Background

At this large academic children’s hospital, providers were required to select a stop date at the time of antibiotic order entry beginning in May 2022. There currently is limited to no published data surrounding the implementation of this practice and its effect on antimicrobial stewardship. This study aims to determine if requiring stop dates on antibiotic orders impacted antibiotic utilization.

Methods

This was a retrospective, pre- post-interventional study of antibiotic usage at a large academic children’s hospital. The pre-invention period was June – November 2020 and 2021. The post-intervention period was June – November 2022. Normalized days of therapy were based on the National Healthcare Safety Network (NHSN) definition. The following indications were selected: empiric for suspected infection, respiratory tract infection (RTI), intraabdominal/gastrointestinal infection, and skin and soft tissue infection. The secondary objective was to subdivide days of therapy, by drug according to the NHSN classifications. Statistical analysis with the Mann-Whitney U test was completed.

Results

The pre-invention group consisted of 3004 patients and the post-intervention group consisted of 1803 patients. There were no major differences between groups, Table 1. The implementation of stop dates decreased total days of therapy per 1000 days present (DOT) from 251 to 235 (p< 0.001) for the entire sample population as well as DOT for empiric indications (153 DOT vs. 124 DOT, p< 0.001), Table 2. For RTI, there was an increase from 42 DOT to 49 DOT (p=0.011). Further analysis revealed an increase in patients with RTI indications and a decrease in duration of therapy from 6 days to 4 days. There was an overall decrease in use of hospital-onset antibiotics (81 DOT vs. 66 DOT, p< 0.001) as well as vancomycin (33 DOT vs. 28 DOT, p < 0.001), Table 3.

Conclusion

After implementation of stop dates, DOT was significantly lower overall and for empiric indication. Decreased usage in hospital onset antibiotics and vancomycin was also seen. The increase in DOT for RTI can be attributed to the increased prevalence in the post-intervention group. Requiring stop dates at the time of antibiotic order entry was associated with lower antibiotic utilization and is a useful tool for stewardship programs.

Disclosures

Sophie E. Katz, MD MPH, Dolly Parton Pediatric Infectious Diseases Research Funds: Grant/Research Support|Optum: Advisor/Consultant|Pfizer: Grant/Research Support Ritu Banerjee, MD, Ph.D, bioMerieux: Grant/Research Support|bioMerieux: company is providing partial support for an ongoing trial unrelated to submitted abstract
1672. Applying Spatial Analyses to Identify Pediatric Risk Factors for Recurrent Staphylococcal aureus Skin and Soft Tissue Infections
Authors: Anderson Daria , Lin Xiting , Mohamed Noor , Immergluck Lilly , Thornton Kevin , Sanders Langdon
Published: November 2023

Background

Community onset Staphylococcus aureus (S. aureus) disproportionately cause skin and soft tissue infections (SSTI) among African Americans (AA). Recurrence of S. aureus SSTI can be seen in >50% of pediatric cases. Risk factors associated with recurrent infections in children are not well reported. We hypothesize that recurrence of S. aureus SSTI in AA children living in Atlanta, Georgia may be related to location-based risks.

Methods

Patients with S. aureus infections from 2011-2019 were included in this retrospective study, using electronic health records (EHR). We included patients who had community-onset S. aureus SSTI, were < 19 years old, and were Georgia resident. Sociodemographic variables collected included race, ethnicity, age, sex, and health insurance. Area-level variables from US Census Bureau included proxies for poverty, education, unemployment, and household crowding. Infections were stratified into MRSA and MSSA by oxacillin susceptibility. Recurrent SSTI was defined as an initial SSTI with one or more subsequent SSTI documented more than 14 days from initial infection within a calendar year. Home address was geocoded and assigned a census tract. Statistical analyses included chi-squared tests and multiple logistic regression to detect differences between patients with recurrent SSTI from non-recurrent SSTI using SPSS. Hotspot analyses were performed at the census tract level to identify hot and cold spots for recurrent SSTI stratified by methicillin susceptibility using ArcGIS Pro.

Results

5,784 unique children presented with S. aureus SSTIs; 64 patients had recurrent SSTI (42 MRSA and 22 MSSA). Females had high proportion (64.1% ) of recurrent SSTIs compared to 48.0% of females with single SSTI (p = 0.011). Females also were significantly more likely to have recurrent MSSA (81.8%) compared to 54.8% of females with recurrent MRSA (p = 0.032). Spatial analysis demonstrated hotspots of recurrent SSTIs in the northern counties of metropolitan Atlanta, whereas single episode SSTIs did not demonstrate this type of spatial distribution.

SSTI Recurrence by County Level

Conclusion

In Georgia, children who are female are at increased risk for recurrent SSTI, and hotspots of patients with recurrent SSTIs are distinct from those with single episodes of SSTIs.

Disclosures

Lilly Immergluck, MD,MS, Melinta: Grant/Research Support|Melinta: Grant/Research Support
1684. Clinical Comparison of Pertussis Infected with Macrolides-resistance and Macrolides-sensitive Bordetella Pertussis
Authors: Guo Fengwei , Deng Jikui
Published: November 2023

Background

To analyze the clinical characteristics and therapeutic outcome of pertussis infected with macrolides-sensitive and macrolides-resistant Bordetella pertussis.

Methods

The clinical data of 154 hospitalized children with pertussis diagnosed by culture in Shenzhen Children's Hospital infectious Department from December 2015 to December 2017 were collected. All children were divided into macrolides-sensitive (MS) group and macrolides-resistant group (MR) according to the results of antimicrobial susceptibility testing. The clinical characteristics and curative effect indexes were compared between these two groups.

Results

From December 2015 to December 2017, 154 children with pertussis diagnosed by culture were admitted to Shenzhen Children's Hospital infectious Department. The median age of children in MR group was 4 (3, 6) months, which was older than that in MS group (Z= 4.38, P< 0. 05). 38 cases (48.71%) in MR group had been vaccinated, which was significantly higher than that in MS group (χ2= 7.24, P< 0.05). 25 cases (32.05%) in MR group had wheezing, which was higher than 12 cases (15.79%) in MS group (χ2= 5.58, P< 0.05). 24 cases (30.77%) in MR group were treated with gamma immunoglobulin, which was more frequently than that in 12 cases (15.79%) in MS group (χ2= 4.82, P< 0.05). Gamma immunoglobulin was used in 24 cases (30.77%) in MR group, which was more common than that used in 12 cases (15.79%) in MS group (χ2= 4.82, P< 0.05). 13 cases (16.67%) in MR group were treated with SMZ-TMP, which was more common than that in MS group (χ2= 13.8, P< 0.05). The logarithmic value of PCR copy number of pertussis in MR group (5.86 ± 1.07) was higher than that in MS group (t= 5.67, P < 0.05).

Conclusion

The macrolides-resistance of Bordetella pertussis was common. Except wheezing, there was no significant difference in other clinical manifestations of children infected with macrolides-resistant or macrolides-sensitive Bordetella pertussis. The infection of macrolides-resistant strains was more common in children who had been vaccinated, and as to the patients infected with macrolides-resistant strains, most of them could be cured effectively with the treatment of erythromycin. Only small part of them need to be treated with SMZ-TMP.

Disclosures

All Authors: No reported disclosures
1689. Comparison of Antibiotics Use between Patients with Kawasaki Disease and Propensity Score-matched Controls: a Cohort Study of 106,908 Patients
Authors: Kim Tae-Hwan , Shin Ji Seong , Kim Sin Young , Jang Min Sik , Kim Jihye
Published: November 2023

Background

The etiology of the Kawasaki disease (KD) has been explained by the influence of infectious agents that interfere with the immune function in genetically susceptible children. In addition of this infectious etiology, we hypothesized that microbial imbalance in the gut from antibiotics use may be an important etiologic factor. We aimed to assess the association between antibiotics use and the development of KD.

Methods

A population-based, case-control study was performed using data from 2010 to 2019 from the Health Insurance Review and Assessment Service (HIRA) database. Various profiles regarding prior antibiotics use since birth were compared between patients with KD and matched controls. Children aged < 5 years who were diagnosed with initial episode of KD from 2016 to 2019 were identified. Propensity score-matched controls without KD were selected from the general population in a 1:5 ratio. Four separate study cohorts according to four different periods of antibiotics use were created: 1) within 28 days after birth; 2) within 12 months after birth; 3) within 6 months from the index date; and 4) within 12 months from the index date. The occurrence of KD were compared between KD cases and controls.

Results

Overall, 17,818 patients with KD and 89,090 matched controls were included in the analysis. Use of antibiotics within 6 months (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.12–1.26) and 12 months (OR, 1.23; 95% CI, 1.14–1.32) from the index date were associated with the development of KD. The association between antibiotics use and KD (OR, 1.26; 95% CI, 1.17–1.37) was most prominent in patients who had received more than three classes of antibiotics within 12 months from the index date. No significant association was observed between the duration of antibiotics use, use of all three major antibiotics classes, or use of any specific antibiotics class and KD.

Conclusion

The development of KD is associated with antibiotics use. However, evidence suggesting that antibiotics use in the neonatal period or within the first 12 months of life is associated with KD is weak.

Disclosures

All Authors: No reported disclosures
1690. Acute Hematogenous Osteoarticular Infections in Children at Siriraj Hospital, Thailand: A 20-Year Retrospective Review
Authors: lertamornkitti nichkamol , Wittawatmongkol orasri , Chokephaibulkit Kulkanya
Published: November 2023

Background

Acute hematogenous osteomyelitis (AHO) and septic arthritis (SA) lead to significant morbidity and sequelae. There are limited data in Thai children.

Methods

This is a single-center retrospective study of patients aged < 18 years who were diagnosed with AHO and SA between 2002- 2021. The acute onset of AHO and SA was defined as the diagnosis of bone and joint infection within 4 weeks after the onset of symptoms or signs in a previously uninfected bone. Data were collected and factors associated with sequelae were determined by using multiple logistic regression analyses.

Results

Of the 110 patients identified, 19 were AHO, 81 were SA, and 10 were combined AHO and SA. The median (IQR) age was 6.7 (1.4-11.9) years and 66 (60%) were male. Fifteen (13.6%) patients were immunocompromised. The most common sites of AHO were tibia (27.6%) and femur (27.6%), and of SA were hips (41.8%) and knees (31.9%). The pathogens were identified in 68 of 106 (64.1%) patients with specimen submission. The positivity rate of hemoculture, synovial fluid, synovial tissues, bone biopsies and vaginal/urethral culture in patients with suspected disseminated gonococcal infection were 32.1%, 40%, 61.9%, 60% and 50% respectively. The most common organisms were methicillin-sensitive Staphylococcus aureus (30.2%) and non-typhoidal Salmonella (9.4%). We found only one case with community-acquired, methicillin-resistant S.aureus. Non-typhoidal Salmonella was responsible for 22.7% of 22 infants. The one-year sequelae were found in 15.8% of AHO, 18.5% of SA, and 20% of combined. In multivariate models, factors associated with sequelae were being immunocompromised (adjusted OR 14.16, 95%CI 1.96-102.35, P=0.009) and infection of the hips (adjusted OR 6.25, 95%CI 1.45-14.59, P=0.025).

Patients' characteristics

Pathogens according to age groups

Factors associated with sequalae

Conclusion

Methicillin-sensitive S. aureus was the most common pathogen among Thai children with acute hematogenous osteoarticular infections. However, Salmonella was the predominant causative organism among infants. Appropriate empirical antibiotic therapy should be effective against both pathogens in infants. Long-term follow up is needed particularly in immunocompromised children and infection of the hip.

Disclosures

All Authors: No reported disclosures
1691. Use of multiplex PCR in pleural effusion: a case series study in a pediatric reference center in Colombia
Authors: Londono-Ruiz Juan Pablo , Vargas-Garcia Andrea , Cardenas-Muller Adriana , Bejarano-Quintero Ana Maria , Mantilla Maria Ximena , Gutierrez-Tobar Ivan Felipe
Published: November 2023

Background

The microbiological diagnosis of pleural effusion (PE) is largely based on methods of classical microbiology. Culture-based methods allow for testing of bacterial susceptibility tests, but these methods take time and frequently have false negative results. We describe the utility of multiplex PCR in pleural fluid for the diagnosis of complicated pneumonia in children using a commercial platform for respiratory samples.

Methods

We conducted a case series of children with complicated pneumonia by PE, empyema or necrotizing pneumonia. Pleural fluid was sent for laboratory to culture, cytochemical and molecular biology testing analysis between 2021 and 2022 in a reference children hospital in Bogotá, Colombia. We used BIOFIRE® FILMARRAY® Pneumonia Panel plus (BioFire Diagnostics, Salt Lake City, Utah). The results were strictly analyzed by a multidisciplinary team. Any change in patient’s therapeutics was decided by this group.

Results

We identified 17 samples that were processed for multiplex-PCR from 16 patients (Table 1). Median age was 3 years (IQR 2-4 years). Pleural empyema was the most common presentation (7/17, 41%), followed by free pleural effusion (6/17, 35%) and necrotizing pneumonia with empyema (4/17, 23,5%). Pathogens were documented in 16 out of 17 (94%) molecular panels performed. Streptococcus pneumoniae was detected in 11/17 (64.7%) multiplex PCR tests, adenovirus was detected in 7/17 (41.1%), and H. influenzae in 2/17 (11.7%) tests. Pneumococcus was isolated in classical cultures in 4 patients (23.5%), of which only one was in pleural fluid. Changes in antibiotic management in 9/17 (52.9%) of the patients. In 5 patients, there was an increase in the antibiotic spectrum, and in 4 patients, there was a decrease in it.

Conclusion

Although the use of this multiplex PCR device is not approved by the FDA for use in pleural fluid samples (off-label), this case series described its usefulness and importance in contexts where there is no other approved PCR technology for these samples.

Disclosures

All Authors: No reported disclosures
1695. Epidemiology of Positive Blood Cultures with Negative BioFire® Blood Culture Identification Panel Results at a Pediatric Center
Authors: Patel Pratik A , Locsin Miguel A , Liu Katie , Jaggi Preeti , Gonzalez Mark D
Published: November 2023

Background

The BioFire® Blood Culture Identification (BCID) Panel is a rapid multiplex PCR assay designed to identify common bloodstream infection (BSI) organisms from positive blood cultures (Figure 1). Although a positive BCID result can identify and often guide pathogen-directed treatment, a negative result may lead to uncertainty. Therefore, we aimed to describe the organisms isolated from cultures with negative BCID tests in pediatric patients.

Figure 1

Targets on the BioFire Blood Culture Identification Panels 1 vs. 2

Methods

In this retrospective study of children (≤ 21 years) in our health system, we extracted all BCID tests performed 01/01/2018 to 03/12/2023 from the electronic medical record (EMR). We excluded positive BCID tests and from the negative tests, excluded duplicates, those with no growth and isolated Gram-positive rod Gram stain. Demographic, clinical, and culture data were abstracted from the EMR. Host status was categorized as previously healthy (PH), chronic condition (CC), and immunocompromised (IC). Descriptive statistics were used to summarize the data.

Results

Of the 4049 BCID tests (3123 BCID1, 926 BCID2) performed, 387 resulted negative (327 BCID1 [10.4%], 61 BCID2 [6.6%]). After applying exclusion criteria, 351 negative BCID tests (296 BCID1, 55 BCID2) from 325 patients were included in the dataset. Among the 351 negative tests, 81 (23.1%) were in PH hosts, 151 (43.0%) in CC hosts, and 119 (33.9%) in IC hosts. The majority (n=208, 59.3%) of negative test results were from cultures drawn peripherally. Eighteen tests (5.1%) resulted in polymicrobial growth, and 156 (44.4%) were not treated as BSIs by the clinician (Table 1).

After the BCID negative result, the median delay in organism identification using conventional methods was 28.9 hours. The 351 cultures from negative BCID tests yielded 372 organisms with the most common Micrococcus spp. (Figure 2).

Table 1

Demographic and culture characteristics of patients with negative BioFire BCID test results: a comparison between BCID1 and BCID2

Figure 2

Top 3 organisms isolated from positive cultures with negative BioFire BCID tests, stratified by patient host status and reported Gram stain

Conclusion

In this large pediatric cohort, the BioFire® BCID1 was negative in 10.4% of tests, decreasing to 6.6% with BCID2. We provide clinicians with a useful resource of organisms isolated from cultures with negative BCID results based on underlying host status. With an identification delay of > 24 hours for the majority of BCID negative tests and many not ultimately treated as BSIs, the impact of negative BCID results on antimicrobial stewardship efforts remains an area of future study.

Disclosures

Pratik A. Patel, MD, Cardinal Health Inc: Advisor/Consultant
1696. Urinary tract infection due to Aerococcus urinae in children
Authors: Sato Eri , Iijima Hiroyuki , Shoji Kensuke , Ogimi chikara , Ishiguro Akira
Published: November 2023

Background

Aerococcus urinae is a rare Gram-positive and catalase-negative coccus. A. urinae is primarily associated with urinary tract infection (UTI). It is responsible for urosepsis and occasionally complicated diseases, including endocarditis and osteomyelitis. The clinical presentations of adult patients with A. urinae have been described. However, there are very few reports in children. The clinical course of UTI due to A. urinae and the associated risk factors remain unclear. The aim of this study was to describe the clinical characteristics of UTI due to A. urinae in children.

Methods

We conducted a retrospective observational study at a tertiary children’s hospital in Tokyo, Japan. We included pediatric patients (< 18 years old) who had positive urine cultures for A. urinae (≥ 104 CFU/HPF) between June 1, 2006, and May 31, 2022. Information regarding clinical characteristics, including age, sex, underlying disease, laboratory test results, antibiotic susceptibility of A. urinae, treatment, and outcomes were collected from the electronic medical records.

Results

A total of 22,769 urine cultures were submitted during the study period, of which A. urinae was isolated in 35 (0.15%). We found 17 patients who were positive for A. urinae with greater than 104 CFU/HPF. Among them, 13 patients (76.5%) were male and 16 (94.1%) had underlying bladder dysfunction. The main clinical symptoms were fever (n=6, 35.3%), urine odor (n=4, 23.5%), and nausea (n=2, 11.8%). Five patients had diagnosed pyelonephritis due to A. urinae. All five patients were male, and the median age at presentation was 4.6 years (range 2.1-11.0 years). Four of them had underlying bladder dysfunction. All bacterial isolates were susceptible to the majority of antibiotics, including penicillin G, sulfamethoxazole, or ciprofloxacin. All patients had favorable outcomes following 10-14 days of ampicillin/amoxicillin-based antimicrobial therapy.

Conclusion

A. urinae was isolated in urine cultures primarily in male patients with underlying bladder dysfunction. All of the outcomes of antibiotic treatment were favorable.

Disclosures

Kensuke Shoji, MD, PhD, AstraZeneca K.K.: Honoraria|Gilead Sciences, Inc.: Honoraria|KYORIN Pharmaceutical Co.,Ltd.: Honoraria|Meiji Seika Pharma Co., Ltd.: Honoraria|Nippon Becton Dickinson Company, Ltd.: Honoraria|Novartis Pharma Co., Ltd.: Honoraria|Viatrs, Inc: Honoraria chikara Ogimi, MD, bioMerieux Japan Ltd.: Honoraria|Horiba: Honoraria|Pfizer: Honoraria
1702. Disseminated Candidiasis after Candidemia: Epidemiology, Diagnostic Evaluation, and Risk Factors
Authors: Whitehurst Daniel , Murphy Catherine R , Teoh Zheyi , Brammer Caitlin N , Perkins Kerrigan , Paulsen Grant C , Danziger-Isakov Lara A , Miller-Handley Hilary , Otto William R
Published: November 2023

Background

In patients with candidemia, evaluation for disseminated disease with ophthalmological exam and diagnostic imaging is recommended but not standardized. This study sought to describe practice patterns in the diagnostic evaluation for disseminated disease after candidemia and identify risk factors associated with disseminated candidiasis to improve local management.

Methods

A retrospective study of all episodes of candidemia diagnosed in patients < 25 years from 2013-2022 at Cincinnati Children’s Hospital Medical Center reported clinical characteristics, microbiology data, and diagnostic testing for dissemination. Disseminated candidiasis was defined as an ophthalmologic exam, echocardiogram or other imaging findings consistent with candidiasis or growth of Candida spp. from a sterile site besides blood. Mixed-effects logistic regression was performed to identify risk factors for disseminated disease.

Results

144 episodes of candidemia occurred in 124 patients , with C. albicans (35%) the most commonly identified species (Figure 1). 107/144 (74.3%) episodes underwent evaluation for disseminated candidiasis, with dissemination in 27/107 (25.2%). Of patients with only 1 positive culture, 5/34 (14.7%) had disseminated candidiasis compared to 22/73 (30.1%) with more than 1 positive culture (Figure 2). Ophthalmologic exams and echocardiograms were done in < 70% of workups (Figure 3). History of prematurity (aOR 17.5, 95%CI 3.1-100.4) and solid organ transplantation (aOR 5.3, 95%CI 1.1-24.6) were associated with disseminated candidiasis when controlling for age, sex, underlying disease, and initial antifungal treatment. Each additional day of candidemia significantly increased the odds of dissemination (aOR 1.5, 95%CI 1.2-1.9).

Conclusion

In this single-center study, most patients with candidemia underwent diagnostic evaluation, though the extent varied. Disseminated disease was common. Prematurity and history of solid organ transplantation were independent risk factors for dissemination as was each additional day of candidemia. Patients with any candidemia should undergo evaluation for dissemination. Multicenter studies are needed to determine the optimal diagnostic evaluation in these high-risk patient groups.

Disclosures

Grant C. Paulsen, MD, Moderna: Grant/Research Support|Pfizer: Grant/Research Support Lara A. Danziger-Isakov, MD, MPH, Aicuris: Contracted Clinical Research|Ansun Biopharma: Contracted Clinical Research|Astellas: Contracted Clinical Research|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Contracted Clinical Research|Pfizer: Contracted Clinical Research|Roche Diagnostics: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: Contracted Clinical Research William R. Otto, MD, MSCE, Moderna: Grant/Research Support
1704. Stenotrophomonas maltophilia Infection in a Neonatal Intensive Care Unit (NICU): A Retrospective Study of Risk Factors and Outcomes in an Inner-City Hospital
Authors: Franco Susannah D , Hammerschlag Margaret , Abdelhemid Ashraf , Fordjour Lawrence , Kohlhoff Stephan
Published: November 2023

Background

Stenotrophomonas maltophilia is an aerobic, non-fermenting, Gram-negative bacillus associated with opportunistic and multi-drug resistant infections. The objective of this study was to identify risk factors and outcomes associated with S. maltophilia isolation or infection in a level IIIB neonatal intensive care unit (NICU).

Methods

This was a retrospective matched case-control study. Cases were matched 2:1 for birth weight, gestational age, and year of NICU admission. The Chi-square test and Fisher’s exact test were used for comparisons of categorical variables. Continuous variables were analyzed with the Mann-Whitney U test.

Results

A total of 15 S. maltophilia isolates were identified from 15 neonates between January 1, 2008 and April 1, 2020 and matched to 30 controls. Median birth weight and gestational age of the cases was 675 g (IQR, 522.5-997.5 g) and 26 weeks (IQR, 24.86-27.14 weeks), respectively. The trachea was the most frequent site of isolation (9 of 15 isolates); colonization was suspected in 2 cases. Other sites included blood (1 case), conjunctiva (2 cases), and peritoneum (3 cases). The following factors were associated with risk of isolation or infection in cases compared to controls: total days of antibiotic exposure (24 vs 15 days, P = 0.01), total number of antibiotic courses (3 vs 2.5, P = 0.043), total days of broad-spectrum antibiotic exposure (19 vs 9.25 days, P = 0.015), and total days of meropenem exposure (9 vs 3 days, P = 0.008). Total length of NICU stay was significantly longer among cases versus controls (134 vs 68.5 days, P = 0.006). Mortality rate was also significantly higher in cases versus controls (N = 15, 33.33% vs N = 30, 0%; P < 0.001); 3 of 3 infants with peritoneal infection died. All 15 isolates were initially susceptible to levofloxacin, and 14 were susceptible to trimethoprim-sulfamethoxazole.

Conclusion

Broad-spectrum antibiotic exposure, especially to meropenem, may lead to selection of resistant bacteria and promote S. maltophilia colonization and infection. S. maltophilia isolation or infection was associated with increased length of NICU stay and mortality.

Disclosures

All Authors: No reported disclosures
1705. Comparative Analysis of Luminometry -vs- Fluorescent Marker Use for Cleaning and Disinfection Processes in a Pediatric Hospital
Authors: Londono-Ruiz Juan Pablo , Cruz-Acevedo Diego Andres , Gaitan-ayala Lina Paola , Prieto-Villarraga Liliana , Correa-Castro Claudia Patricia , Gutierrez-Tobar Ivan Felipe
Published: November 2023

Background

The cleaning and disinfection process (CDP) of hospital surfaces has proven to be an effective tool in preventing healthcare-associated infections. ATP bioluminescence meters have been established as the standard for CDP evaluation. The use of fluorescent markers has also been established as an alternative to this. The aim of this study was to assess the concordance between luminometry measurements and fluorescent marker use in the CDP of a pediatric hospital.

Methods

A diagnostic test study was conducted in which luminometry (Clean-Trace™ LX25 - 3M™) was compared with the use of a fluorescent marker (West Scan - West Química). Joint relative light units (RLU) were taken, and a subjective scale was used to define the erasure of the fluorescent marker after the cleaning and disinfection process (completely erased, partially erased, and intact). The process was established as adequate when less than 65 ATP units were obtained in critical sites and less than 175 in general hospitalization sites. The R program v 4.2.2 was used for data analysis.

Results

We performed 292 paired measurements: 222 (76%) in critical areas and 70 (24%) in non-critical areas. Measurements were taken from different high-contact surfaces such as crash carts, monitor screens, worktables, dressing carts, and defibrillators, among others. The luminometries carried out in 244 (83.5%) were adequate, and the measurements with fluorescent marker showed that 187 (64%) presented total erasure, 37 (12.6%) showed partial erasure, and 66 (22%) were intact. The Kappa index between both tests for total erasure was calculated as adequate, being 0.155 (p-value 0.002). When the tests with the criteria of partial or total erasure were compared as adequate, the Kappa index was 0.007 (p-value 0.6). When they were sub-analyzed according to the areas (critical and non-critical), a kappa value of 0.141 (p-value 0.02) was found for critical areas and 0.194 (p-value 0.03) for non-critical areas.

Conclusion

The correlation between the evaluation of the cleaning and disinfection process using a luminometer and a fluorescent marker showed slight agreement for total erasure. More studies are required to understand the reasons for this low correlation.

Disclosures

All Authors: No reported disclosures
1706. Risk factors for infections caused by extended spectrum beta lactamase (ESBL) producing and Carbapenem-resistant Enterobacterales (CRE) in pediatric critical care settings: A case control study
Authors: Omar Amr , Asmar Basim , Abdel-Haq Nahed M
Published: November 2023

Background

Infections due to Gram negative resistant bacterial pathogens are a major concern in intensive care units. The purpose of this study is to determine the risk factors for developing ESBL-producing and CRE infections in pediatric patients in critical care settings (PICU and NICU).

Methods

A retrospective case control study of infections due to ESBL-producing and CRE during a 5-year period (2016-2021) at Children’s Hospital of Michigan, Detroit. All patients had positive cultures during their PICU/NICU stay. Control cases were matched for age, infection site and year of infection but their cultures grew Enterobacterales that were non-ESBL or carbapenemase producers.

Results

A total of 58 patients with ESBL/Carbapenemase-producing Enterobacterales (cases) and 59 control patients were included. Majority of organisms were E. coli and Klebsiella species recovered from respiratory tract. There was no difference in both groups in regards to age, gender, race or length of hospital stay (p >0.3). There was no difference in prior hospital admission, PICU or NICU stay during the previous 6 months, indwelling devices, comorbid conditions, or surgery in the last 6 months (p >0.3). However, the presence of gastrostomy tube was more frequent in the cases group (29.3%) than the control group (15.3%) (p=0.078). Risk factors by univariate analysis included history of antibiotic use in last 6 months (93% in cases vs 73% in controls; p=0.006), cephalosporins use > 14 days (67% vs 31.2%; p=0.006),Trimethoprim/Sulfamethoxazole treatment duration > 14 days (11.1% vs 0%; p=0.012), carbapenem treatment duration > 14 days (14% vs 1.9%; p=0.027), and vancomycin use > 14 days (43.6% vs 21.6%; p=0.053). However, multivariate logistic regression analysis showed that antibiotic usage in the last 6 months was the single best predictor for cases with odds ratio of 5.02-fold (95% CI 1.56-16.13) (p=0.007).

Conclusion

Prior broad spectrum antibiotic usage was significantly associated with acquisition of ESBL and carbapenemase producing Enterobacterales. The study further underscores the need for optimizing antimicrobial stewardship practices to limit unnecessary and prolonged use of antibiotics to prevent the emergence of resistant pathogens.

Disclosures

All Authors: No reported disclosures
1707. New directions for infection prevention in the neonatal intensive care unit: A key informant exploration
Authors: Prestel Christopher , Barnes Laura , Kuhar David , Sinkowitz-Cochran Ronda
Published: November 2023

Background

Prolonged hospitalization and unique physiology of neonates and infants places them at risk for healthcare-associated infections (HAIs) in the neonatal intensive care unit (NICU). Development of infection prevention (IP) bundles led to decreases in HAIs in NICUs. We interviewed key informants to understand the IP challenges and opinions of NICU clinicians to inform unique IP needs in NICUs.

Methods

Participants were referred by the Vermont Oxford Network (VON), an interdisciplinary NICU quality improvement (QI) community. A standard set of questions were used for all interviews, which covered perceived IP gaps, opportunities for QI improvement, barriers, and implementation practices. Qualitative analysis was performed using NVivo software with three key questions coded using an immersion-crystallization technique. Transcripts were systematically reviewed by a team of three coders to maintain intercoder reliability.

Results

Eight subject matter experts (SMEs) were interviewed. Participants included five neonatologists, two pediatric infectious diseases physicians, and a pediatric critical care medicine physician. All participants practiced or held IP roles within a Level III or IV NICU; three were in the Northeast, three in the Midwest, and two in the Southeast region of the U.S. The most common themes to emerge across participant responses were poor hand hygiene compliance rates, inherent complexities of providing care in the neonatal population, and balancing family presence with IP concerns. The greatest opportunities for IP improvement described by SMEs were the development of novel supplemental IPC strategies to complement core practices, antibiotic stewardship in neonates, and the prevention of ventilator-associated pneumonia. The most cited barriers were a lack of evidence-based research, NICU staffing turnover and inexperience, and gaps in provider and family knowledge of IP practices.

Conclusion

Identified IP challenges within the NICU are unique and cross-cutting among patient, provider, and family needs. These may be mitigated through the development of new HAI prevention tools, education, and resources developed specifically for this complex care environment.

Disclosures

All Authors: No reported disclosures
1711. Prospective Environmental Surveillance of Floors in a Pediatric Emergency Department During a Respiratory Syncytial Virus Surge in Ottawa, Canada
Authors: Thampi Nisha , Moggridge Jason , Khov Engluy , Hinz Aaron , Castellani Lucas , Doukhanine Evgueni , Hug Laura , Kassen Rees , MacFadden Derek , Nott Caroline , Wong Alex , Fralick Michael
Published: November 2023

Background

Annual respiratory syncytial virus (RSV) epidemics disproportionately impact infants and young children. Clinical surveillance is often restricted to laboratory-confirmed hospitalizations. Built environmental surveillance through floor sampling may provide population-level insights into RSV transmission dynamics and inform public health action to blunt community outbreaks.Figure:Quantification of viral detection from floor swabs in the pediatric emergency department by multiplex PCR

Each point represents the number of viral copies, plus one, detected from a swab captured at a given location (y-axis) on a given date (x-axis). A value of one copy indicates non-detection of RSV.

Methods

A prospective environmental surveillance study was conducted in Ottawa, Canada from November 24, 2022 to March 24, 2023. Floors were swabbed in six areas of the emergency department (ED) of the sole pediatric acute care facility in Eastern Ontario. Samples were tested for RSV by a validated multiplex PCR assay. Floor swab positivity was compared to hospitalization data of patients with laboratory-confirmed RSV using Pearson’s correlation analysis to determine the degree of their association.

Results

Over an 18-week period, 432 floor swabs were collected in the ED and 250 pediatric patients were hospitalized. RSV was detected in 65% of floor swabs, with more viral copies detected in congregate areas (waiting rooms, triage) (Figure). The correlation between swab positivity and RSV hospitalizations was 0.64 (95%CI 0.23-0.86).

Conclusion

RSV was frequently detected on floors in the hospital-built environment and correlated somewhat with hospitalizations, likely reflecting community viral prevalence rather than severe RSV disease. Having real-time floor signals in different areas of the ED allowed for spatial resolution of the signal intensity, identifying higher RSV burden in areas where patients with infectious symptoms were more likely to congregate for prolonged periods of time. Floor sampling may be useful in developing spatially-refined approaches to infection prevention and control measures, particularly in indoor areas with increased respiratory viral transmission risks.

Disclosures

Evgueni Doukhanine, MSc, DNA Genotek: DNA Genotek provided sampling swabs in-kind for this study in an unrestricted fashion. Michael Fralick, MD, ProofDx: Advisor/Consultant