bluuebunny/crossref_metadata_2025 huggingface dataset:
1668. Antibiotic Usage Trends Following Implementation of Handshake Stewardship at a Tertiary Care Children's Hospital
Authors: Weiner Lukasz , Auerbach Sarah , Kinn Patrick M
Published: November 2023

Background

Antimicrobial stewardship was implemented at the University of Iowa Stead Family Children’s Hospital in November 2018 principally through handshake stewardship with pediatric intensive care and hospitalist teams. We sought to evaluate the impact of this intervention on the use of select antibiotics targeting P. aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA).

Methods

Use of select anti-pseudomonal (cefepime, piperacillin/tazobactam and meropenem) and anti-MRSA (vancomycin, linezolid and daptomycin) agents within our pediatric intensive care unit (PICU) and pediatric wards (L9 and L10) was retrospectively reviewed. Mean days of therapy (DOT) per 1000 patient days (PD) was aggregated and trended annually from January 2018 until December 2022. Simple linear regression analysis was conducted to detect significant changes in antimicrobial use over time.

Results

Use of anti-pseudomonal and anti-MRSA agents in the PICU declined by 40% and 29%, an absolute reduction of 99 and 60 DOT/1000 PD, respectively (P-value: 0.0366 and 0.0210, respectively) (Figure 1). Use of anti-MRSA agents on L10 declined by 52% (absolute reduction of 53 DOT/1000 PD; P-value: 0.0263), but only declined by 6% on L9 (Figure 2, Figure 3). Use of anti-pseudomonal agents on L10 declined by 56% (absolute reduction of 44 DOT/1000 PD; P-value: 0.0522), but only declined by 10% on L9 (Figure 2, Figure 3).

Figure 1: Mean Days of Therapy Per 1000 Patient Days of Anti-Pseudomonal and anti-MRSA Usage in the PICU Figure 2: Mean Days of Therapy Per 1000 Patient Days of Anti-Pseudomonal and anti-MRSA Usage on L9 Figure 2: Mean Days of Therapy Per 1000 Patient Days of Anti-Pseudomonal and anti-MRSA Usage on L10

Conclusion

Implementation of a handshake stewardship intervention strategy was associated with decreasing DOT of select antibacterial agents. The inability to significantly impact antimicrobial usage on L9 was potentially impacted by this being a mixed unit with subspecialty and surgical services. Expansion of handshake stewardship to subspecialty and surgical services may further reduce usage on mixed units.

Disclosures

All Authors: No reported disclosures
1670. It Is Likely Not HSV: Decreasing Empiric Acyclovir Use In Low-Risk Infants
Authors: Junquera Guillermo Yepes , Taveras Jeanette , Watson Joshua R , Abdel-Hadi Malak , Erdem Guliz
Published: November 2023

Background

Neonatal HSV infection is a rare but potentially devastating disease. Institutional practices regarding which neonates must be treated empirically with acyclovir varies. While some centers elect to treat all neonates presenting with fever or hypothermia, some treat only those considered at risk. Our goal was to decrease empiric acyclovir use in low-risk neonates admitted to the Infectious Disease (ID) ward.

Methods

Quality improvement initiative aimed to decrease acyclovir exposure in neonates 15 to 28 days old hospitalized on the ID ward for fever/hypothermia without a focus, risk factors, or clinical signs for HSV (Figure 1). Interventions included development of a risk stratification algorithm (Figure 2), consensus building among Emergency Medicine and ID providers, and order set implementation. We reviewed all neonates with HSV infections for delayed acyclovir initiation as a balancing measure. The pre-study baseline period was 2019 to 2020, and the study period was 2020, to March 31, 2023. Control charts were used to assess the interventions.Figure 1Key Driver Diagram.Figure 2Risk stratification algorithm for HSV empiric treatment in low-risk infants.

Results

The mean acyclovir use per quarter in neonates who met low risk criteria decreased from 79% during the baseline period (7/2019-6/2020) to 30% in the post-intervention period (7/2020-3/2023) (p = < 0.0001) (Figure 3). Most common reasons why patients failed low risk criteria were: CSF pleocytosis in the setting of a traumatic LP, minimally abnormal lab values (slightly increased ALT, slightly decreased platelets), no LP in well-appearing patient and alternative fever etiology (URI symptoms with positive respiratory infection array). There were no cases of delayed acyclovir initiation in patients with HSV disease. Only one patient with HSV disease fell within the age range but was admitted to the ICU following cardiac arrest and appropriately started on acyclovir therapy.Figure 3Control chart of empiric acyclovir use in low-risk infants.

Conclusion

Our algorithm, targeted to limit empiric acyclovir therapy in neonates with fever/hypothermia without a focus at low risk for HSV, led to a significant decrease in acyclovir exposure sustained for > 2 years after implementation. Interestingly, it also led to decreased in acyclovir use in patients who failed low risk criteria, but this did not result in missed diagnosis of HSV disease, likely because our algorithm was conservative and HSV infection is rare.

Disclosures

All Authors: No reported disclosures
1671. Impact of COVID-19 Pandemic on Rates of Positive Blood Cultures and Contaminations in Children
Authors: Aiba Hiroyuki , Yamada Masaki , Matsui Toshihiro , Ogimi chikara
Published: November 2023

Background

The global COVID-19 pandemic has led to many changes in infection prevention policies and practices in healthcare settings. For example, healthcare providers need to use personal protective equipment during all procedures, including phlebotomy. Blood culture is a widely used test for diagnosing bloodstream infection, and a few publications have reported an increase in its contamination rate in the pandemic era. However, the changes in the culture contamination rate and bacteremia in children have barely been assessed. Hence, we performed a retrospective review of blood culture results during the COVID-19 pandemic era.

Methods

A retrospective, observational study was performed at a tertiary children's hospital in Japan.

The monthly numbers of blood cultures drawn and the blood culture results of the children aged ≤ 18 years who visited the emergency room (ER) at our center from January 2017 to December 2022 were collected using electronic medical records and a clinical database. Of note, all positive culture results were reviewed by pediatric infectious specialists and were interpreted whether the results were true positive (bacteremia) or contaminated. The study period was divided into two eras for comparison: the pre-COVID-19 pandemic era (January 2017-December, 2019) and the pandemic era (January, 2020-December, 2022). Mann-Whitney U test was used for analysis, with a p-value of less than 0.05 being significant.

Results

Overall, the number of pediatric patients presented to the ER was 83,224 in the pre-pandemic period and 57,742 during the pandemic period (Figure 1). The numbers of blood culture specimens were 12,571 and 9,409, respectively. The median (interquartile range) monthly numbers of blood cultures drawn per 1,000 patient visits were 148 (137–164) and 156 (144–173) (p = 0.12) (Figure 2). Similarly, the contamination rates were at 1.5 (0.8–2.1) and 1.7 (1.9–2.3) (p = 0.53), while the rates of patients with bacteremia were 2.1 (1.6–3.0), and 2.9 (2.1–4.3), the latter being significantly higher (p = 0.02).

January 2020 was defined as the COVID-19 pandemic.

Comparison by Mann-Whitney U test before and during the COVID-19 pandemic

Conclusion

The COVID-19 pandemic did not appear to increase the blood culture contaminants in the pediatric ER at a tertiary center. However, the rate of bacteremia increased during the pandemic. Explanations for this observation will continue to be investigated.

Disclosures

chikara Ogimi, MD, bioMerieux Japan Ltd.: Honoraria|Horiba: Honoraria|Pfizer: Honoraria
1677. Trends in Antibiotic Resistance Among Uropathogens in the Pediatric Population: A Multicenter Experience in the US
Authors: Mithal Leena B , Chu David , Forster Catherine , Kalu Ibukun , Wiener John , Sun Shan , Fishbein Joseph , Arshad Mehreen
Published: November 2023

Background

Urinary tract infections (UTIs) are common infections in children. Overuse of antibiotics has led to increasing antibiotic resistance among uropathogens in adults; however, data on pediatric trends have not been previously reported. Our objective was to characterize antibiotic resistance trends in uropathogens among children at three tertiary care hospitals across the US.

Methods

Microbiologic data from positive urine cultures ( >20,000 CFU/ml) in children 0 – 18 yrs of age between 1/1/2010 and 12/31/2020 were obtained from electronic medical records. Yearly antibiotic agent-specific resistance rates were calculated based on culture, patient, and organism level data.

Results

A total of 17,747 positive individual urine cultures were analyzed. E. coli was the most common organism isolated. Across all three institutions, rates of resistance against ampicillin/sulbactam (average rate 24%, IQR 3.21%) and trimethoprim/sulfamethoxazole (average rate 30%, IQR 6.42%) among E. coli remained high but stable over the study period. However, resistance against levofloxacin as well as third and fourth generation cephalosporins generally increased over this period across all institutions (Figure 1) and age groups (Figure 2). Combined antibiograms of all three institutions for 2019 and 2020 showed high rates of resistance against ampicillin/sulbactam and trimethoprim/sulfamethoxazole among Enterobacterales in general and variable resistance against ceftriaxone.

Conclusion

Over the last 10 years, there have been rising rates of resistance to broad spectrum antibiotics, including beta-lactams and quinolones, among uropathogens collected from a pediatric cohort with an increasing trend starting in 2015-2016. While we were not able to distinguish patients with community acquired UTI from hospital acquired UTIs, we noted with interest that the prevalence of resistant uropathogens even among the youngest age groups (< 30 days and < 1 year) trends along with the older children. This suggests a likely community reservoir of multi-drug resistant gram-negative bacteria. Colonization by resistant uropathogens has implications for empiric antibiotic choice, limited oral therapy options, and clinical outcomes which necessitate further study.

Disclosures

Ibukun Kalu, MD, Pfizer: Institutional support for clinical trial
1683. Severe Group A Streptococcus Infections Amongst Pediatric Patients in the Lehigh Valley, Pennsylvania Following the COVID-19 Pandemic
Authors: Gough Stormie , Berback Jonathan , Villalobos Tibisay
Published: November 2023

Background

In December 2022 the CDC issued an alert about possible increase of invasive group A Streptococcus infections (iGAS) among children in the United States. Colorado and Minnesota observed an increase in the number of cases in the Fall 2022. Similarly, the Pennsylvania Department of Health issued a health alert that was then lifted in February 2023. Preliminary CDC data showed that iGAS infections were higher in some areas of the country compared to pre-pandemic levels. Lehigh Valley Reilly Children’s Hospital is a community teaching hospital in Allentown, Pennsylvania. A rise in the number of children admitted with GAS infections was noted in the same period compared to previous years. The aim of our study was to determine the clinical characteristics of patients admitted with iGAS and non-iGAS infections during fall and winter 2022-2023.

Methods

Retrospective chart review of patients 18 years and younger admitted to Reilly Children’s Hospital between September 1st 2022 through March 31st 2023 and diagnosed with GAS infection plus those admitted with the same diagnosis between 2018 and 2022.

Results

There were 19 children admitted to the hospital with GAS infection: 6 (32%) with iGAS and 13 (68 %) with non-iGAS infections. The iGAS infections included bacteremia without source (2), myositis (1), pneumonia (2), and vascular infection (1). Non-iGAS infections included retropharyngeal abscess (3), peritonsillar abscess (2), parotid abscess (1), submandibular abscess (1), lymphadenitis (2), mastoiditis (1), cellulitis (1), pharyngitis (1), and erythema nodosum (1). Six children required intensive care and two were transferred to higher level care. Median age was 2.2 year for iGAS infections and 4.8 years for non-iGAS. All but one patient had no underlying medical conditions. There were no patient deaths. In 2018 there were zero cases of iGAS infection; in 2019: two cases; 2020: two cases; 2021: zero cases. There were no admissions between May 2020 and April 2022 for either iGAS or non-iGAS.

Conclusion

The number of children admitted for iGAS and non-iGAS infections in the fall and winter of 2022-2023 surpassed the preceding 4 years combined. This is reflective of what was happening in some other areas of the country as a result of reduced exposure and lack of immunity due to pandemic restrictions.

Disclosures

All Authors: No reported disclosures
1687. Unprecedented Outbreak of Invasive group A Streptococcus Infections in Children - Colorado, October 2022 to March 2023
Authors: Ho Erin C , Silveira Lori , Birkholz Meghan C , Cataldi Jessica R , Dominguez Samuel R
Published: November 2023

Background

Since the fall of 2022, we have observed a sharp rise in pediatric invasive group A Streptococcus (iGAS) hospitalizations in Colorado, similar to trends reported in other countries.

Methods

From October 2022 – March 2023, iGAS cases were prospectively identified in patients hospitalized at Children’s Hospital Colorado and medical charts were systematically reviewed. iGAS was defined as isolation of GAS from a sterile site (confirmed case) or a non-sterile site with clinically consistent disease (probable). Using laboratory specimen records, we compared the number of patients with sterile site GAS-positive cultures across three time periods: Pre-COVID-19 (Jan 2015 – Mar 2020), COVID-19 pandemic (Apr 2020 – Sep 2022), and Outbreak (Oct 2022 – Mar 2023).

Results

Among the 81 iGAS cases identified during the outbreak (Table 1), median age was 6 years old; 64% of patients were male and 69% were previously healthy. 33% of patients required pediatric intensive care unit (PICU) admission, and two patients died. iGAS was more commonly associated with upper respiratory infection (URI) symptoms (63%) than isolated sore throat (5%) or trauma/skin findings (15%). The most common clinical manifestations were head and neck infections (37%), musculoskeletal infections (32%) and pneumonia (20%). 11% had toxic shock syndrome and 4% had necrotizing fasciitis. Lab findings associated with PICU admission were bandemia, leukopenia and higher CRP values. Disease severity and treatment varied by clinical manifestation (Table 2). There were more iGAS cases during the outbreak (average 10.0/month) compared to pre-pandemic years (3.8/month over the same period) and during the pandemic (1.2/month over the same period) (Figure 1).

Conclusion

We report an unprecedented outbreak of iGAS in pediatric patients in Colorado, with case numbers close to triple the pre-pandemic baseline at our hospital. The timing and high proportion of cases with associated URI symptoms suggest a link to the recent surges in respiratory viruses, although iGAS cases have continued to persist past the peak of respiratory season. Invasive GAS can be severe and evolve rapidly; there are important clinical and laboratory features that may help in earlier identification of children who are critically ill.

Disclosures

Samuel R. Dominguez, MD, PhD, Biofire Diagnostics: Advisor/Consultant|Biofire Diagnostics: Grant/Research Support|Cobio Diagnostics: Board Member|Karius: Advisor/Consultant|Pfizer: Grant/Research Support
1694. Joint Fluid Cell Count of Septic Arthritis Patients Diagnosed with Positive Culture in Children
Authors: Otsubo Yuto , Shibata Meiwa , Ota Norikazu , Hataya Hiroshi , Horikoshi Yuho
Published: November 2023

Background

Septic arthritis is one of serious pediatric infections that could result motor comorbidities. Historically, joint fluid cell count of 50,000 and over cells/mm3 has been used for presumptive diagnosis of septic arthritis while awaiting for culture result. Our aim of study was to evaluate joint fluid cell count for diagnosis among septic arthritis patients confirmed with positive culture in children.

Methods

Patients with septic arthritis were included at Tokyo Metropolitan Children's Medical Center from March 2010 to March 2023. Septic arthritis was confirmed with positive joint fluid culture for a pathogenic organism. Patients with negative joint fluid culture and patients without joint fluid cell count were excluded. Electrical charts were retrospectively reviewed for demographic data, timing of arthrocentesis, culture result and joint fluid cell count.

Results

A total of 95 patients with septic arthritis were identified. After excluding patients with negative culture and without joint fluid cell count, 22 patients were included for our study. Median age was 5 (IQR: 2-10) years old. Girl ratio was 45%. The median joint fluid cell count was 19,575 (IQR: 6,806-47,388) cells/mm3. Patients with 50,000 and over cells/mm3 was 23%. The median time from onset to arthrocentesis was 3 (IQR: 2-5) days. The isolated organisms were methicillin-susceptible Staphylococcus aureus (50%), methicillin-resistant S. aureus (9%) and Streptococcus pyogenes (27%), Streptococcus pneumoniae (5%), Klebsiella pneumoniae (5%) and Salmonella spp (5%). The infected joints were hip (59%), knee (23%), ankle (14%), elbow (5%) and shoulder (5%). One patient had hip and ankle arthritis. Nine patients were complicated with septic osteomyelitis. The Pearson correlation coefficient between days from onset of symptoms to puncture and the number of joint cells was 0.093 (p=0.681). (Figure 1)

Conclusion

Majority of patients with septic arthritis confirmed with joint fluid culture did not exceed joint fluid cell 50,000 cells/mm3.

Disclosures

All Authors: No reported disclosures
1701. Trends in Invasive Candidiasis in Children with Hematologic Malignancies: Increased Risk of Dissemination with Non-albicans Candida
Authors: Said Amira , Afridi Faraz , Daignault Chelsea , O’Farrell Candelaria , Scheurer Michael E , Redell Michele S , Garnes Natalie J Dailey , Gramatges Maria , Dutta Ankhi
Published: November 2023

Background

Candida species are the most common cause of invasive fungal infections in hospitalized patients. Children with hematological malignancies are at increased risk. The epidemiology of species implicated in invasive candidiasis (IC) has changed over the past 25 years with non-albicans Candida (NAC) species now prevailing. These changes have therapeutic and prophylactic implications as some species carry intrinsic resistance to widely-used antifungal medications.

Methods

Patients ages 0-18 with hematologic malignancy and at least one episode of IC from 2011-2022 from two institutions were included. Patients who had received a bone marrow transplant were excluded. Information related to demographics, host factors, clinical risk factors, Candida species and antifungal minimum inhibitory concentrations (MICs), treatment and outcomes was collected via retrospective chart review.

Results

53 cases of IC were identified. Sixty percent were males. Thirty (57%) were of Hispanic ethnicity. The median age at diagnosis was 9 years (range 2 months-18 years). Seventy percent (37/53) had B-cell acute lymphoblastic leukemia. The median time to IC from diagnosis of cancer was 95 days (IQR 20-277). C. tropicalis (n=17; 32%) and C. albicans (n=14; 26%) were the most common species followed by C. glabrata and C. parapsilosis. Thirty-five percent (18/53) had concurrent bacteremia. The most common sites of dissemination were the lungs (n=24, 45%), kidneys (n=17; 32%), liver (n=15, 28%) and spleen (n=14; 27%). Of the 35 patients who underwent dilated eye exams, 23% (n=8) had ophthalmologic involvement. NAC were more likely to disseminate to the eyes, skin and spleen than C. albicans (p< 0.05). Fourteen isolates (26%) demonstrated increased MICs to fluconazole and six demonstrated increased MICs to voriconazole. Most (59%) required more than 6 weeks of antifungals. Sixteen patients died, of which six were attributed to IC.

Conclusion

NAC accounted for most of the IC in hematological malignancies with C.tropicalis being the most common. The implications of NAC being predominant in this high-risk group is concerning due to the higher MIC to azoles and the potential for azole resistance in the future. Antifungal prophylaxis and treatment both need to be reevaluated periodically based on these findings.

Disclosures

Natalie J Dailey Garnes, MD, MPH, AlloVir: Grant/Research Support
1703. Pseudo-Outbreak of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit: Implications for Surveillance
Authors: Dauphin Ashley , Gordon Patrick S , Story Gina L , Gupta Munish , Schultz Jordan , Doucette Matthew , Cumming Melissa , Longhi Lorinda , Kirby James , Mehrotra Preeti
Published: November 2023

Background

We conduct weekly surveillance screening for methicillin-resistant Staphylococcus aureus (MRSA) in our neonatal intensive care unit (NICU). In September 2021, we noted an increase in positive MRSA screening results and identified 2 patients with MRSA wound infection. We conducted an investigation to explore the possibility of in-unit transmission.

Methods

We launched a multi-pronged investigation that included additional patient screening. Surveillance isolates were assessed for the presence of MRSA using chromogenic agar. Additional antimicrobial sensitivity testing was performed on an automated bacterial identification system if chromogenic agar results were inconclusive, fig 1 & 2. We also conducted audits of staff hand hygiene, enhanced cleaning and disinfection of shared patient-care equipment, implemented standardized chlorhexidine gluconate (CHG) scrub use for NICU staff upon unit entry, and added new CHG bathing for certain patients.

Positive control chromogenic agar plate

Ambiguous chromogenic agar results

Results

Over the course of a 6-week long investigation, 18 neonates were found to be MRSA-positive on surveillance swabs using chromogenic agar. In the first 2 weeks of the investigation, PFGE showed that 9 MRSA isolates were genetically distinct. Over the next weeks, additional MRSA-positive surveillance swabs were collected and ultimately 15 isolates underwent whole genome sequencing at the Mass. State Public Health Laboratory. Only 2 pairs of isolates appeared related. Antimicrobial resistance genes were identified and revealed only 6 of the 15 isolates contained the mecA gene consistent with MRSA. As a result, all 18 positive surveillance swabs obtained during the investigation underwent full identification and sensitivity testing confirming only 6 samples contained MRSA and 12 contained methicillin-sensitive Staphylococcus aureus (MSSA). Testing discordance with breakthrough MSSA growth was reported to the chromogenic agar manufacturer.

Conclusion

Our investigation identified that an increase in MRSA-positive surveillance swabs was a pseudo-outbreak due to false-positive MSSA growth on MRSA selective media. At the conclusion of this investigation, the need for ongoing surveillance swabs was re-evaluated and ultimately discontinued. Clinical NICU specimens are now monitored in real-time by Infection Control.

Disclosures

James Kirby, MD, D(ABMM), Abbott Molecular: Educational Grant
2877. Influence of vancomycin AUC monitoring on acute kidney injury in a large quasi-experimental study of over 3000 patients
Authors: Gregory Eric , Schadler Aric , Burgess David , Burgess Donna R , Cotner Sarah , VanHoose Jeremy , Wallace Katie L
Published: November 2023

Background

Due to the inconsistent correlation of vancomycin trough concentrations with area under the curve (AUC) and increased rates of vancomycin-induced kidney injury (VIKI), an institutional practice change was implemented in 2017 to use 2-level AUC monitoring. The objective of the present study was to evaluate VIKI outcomes in a large quasi-experimental study.

Methods

A 4-year quasi-experimental study was performed at an academic medical center and included patients who received parenteral vancomycin for ≥ 72 hours. The primary outcome was the incidence of VIKI defined using KDIGO criteria. Secondary outcomes included inpatient all-cause mortality, median length of stay (LOS), median intensive care unit LOS, and median vancomycin trough concentration. Multivariable logistic regression analyses were used to identify primary predictors of VIKI and all-cause inpatient mortality while controlling for other significant covariates.

Results

The study included 3207 patients, with 1964 and 1243 in the trough and AUC groups, respectively. Similar baseline demographics (i.e., age, sex, race, weight, BMI, CrCl, Charlson Comorbidity Index) were noted between the groups. Patients in the AUC group were more likely to receive a vancomycin loading dose (32% vs 49%; p< 0.001) and have greater median trough concentrations (11.5 mg/L [8.1-16.0] vs 11.8 mg/L [8.9-16.2]; p=0.008). However, they also had lower median day 3 vancomycin exposures (3500 mg [2250-5000] vs 3250 mg [2500-4500]; p=0.008). Median AUC was 488 (396-607) in the AUC group. No significant differences were noted in the bivariate analysis of VIKI, defined as meeting criteria of any of the 3 KDIGO stages (20.5% vs 19.6%; p=0.112). The multivariable logistic regression suggested AUC monitoring was associated with a 23% decrease in VIKI (OR 0.767; 95% CI 0.621-0.947). All-cause inpatient mortality was significantly decreased in the AUC group (8.1% vs 6.3%; p=0.049).

Conclusion

VIKI was significantly reduced when AUC monitoring was employed in a large quasi-experimental study comprising over 3000 patients, one of the largest evaluations to date. This further strengthens the recommendation to transition to AUC monitoring for most patients receiving vancomycin for ≥ 72 hours.

Disclosures

All Authors: No reported disclosures
1709. Shifting Infection Spectrum in Febrile Neutropenic Pediatric Cancer Patients During the COVID-19 Pandemic: An Impact Assessment
Authors: Dabas Aditya , Sharma Vagisha , Singh Amitabh , Kriplani Kushal , Gaind Rajni , Gera Rani
Published: November 2023

Background

Febrile neutropenia (FN), which is the most common reason for hospital admission among pediatric oncology patients recieving chemotherapy, has seen changes in the epidemiology of infectious pathogens over the past few decades. This is attributable to shifts in hospital flora, antibiotics usage, and resistance patterns. Previously, bacterial infections were more common in this population, with mycobacterial, viral, and protozoal organisms being less frequent. Gram-negative bacteria such as E. coli, Klebsiella, and Pseudomonas were the most common causative agents. However, with the onset of the COVID-19 pandemic, the implementation of nationwide lockdowns, reduced healthcare visits, and strict interpersonal preventive measures are anticipated to impact the previous trends.

Methods

A 16-month prospective observational study was conducted on 131 eligible pediatric cancer patients (ages 1-12) admitted with febrile neutropenia from Dec 2019 to May 2021. Causative pathogens were identified through lab investigations upon admission, and on days 3 and 7.

Results

Out of the 131 children enrolled in the study, an etiological agent could be identified in 72. SARS-CoV-2, Acinetobacter, and Klebsiella accounted for over 50% of the infections. SARS-CoV-2 was the most common pathogen, and non-SARS-CoV-2 coronaviruses were also detected, even more than E. coli.Overall, gram-negative infectious agents comprised the most common pathogens (35.2%), similar to the pre-COVID era, followed by an appreciably increased respiratory viral burden (32.3%), a markedly decreased proportion of gram-positive infections (11.2%), and lastly, a largely unchanged fungal contribution (11.2%).

Major etiological agents in febrile neutropenia patients

Conclusion

Rigorous interpersonal precautions and hygiene practices that were reinforced during the pandemic are effective in preventing hospital-acquired and contact-transmitted infections caused by gram-positive bacteria. However, despite the strict preventive measures and travel restrictions, transmission of airborne infections between immunocompromised patients and their caregivers was not avoided and became the most prevalent infection in the group. The risk of infection from the overgrowth of endogenous gram-negative flora remains unchanged.

Disclosures

All Authors: No reported disclosures
1727. Household Vaccination Status and Attitudes towards Pediatric COVID-19 Vaccination: A survey at four New Jersey clinic-based pediatric practices
Authors: Katic Bozena J , Alvitres Jessica L , Hasan Uzma , Katragkou Aspasia , Friedman Stephen M , Schwab Joseph V , Weller Alan , Thomas Pauline , Kennedy Mary C , Li Charles , Gurumurthy Manisha , Rohan Claudia , Chu Dorothy , Hussein Mawada , Shaikh Mehek , Damania Bijal , Morisetty Harini , Godfrey Grayland W , Gaur Sunanda , Noor Hathija
Published: November 2023

Background

Although COVID-19 vaccination has been recommended for all children 6 months of age and older since August 2022, vaccine uptake among the pediatric population is low. Underlying caregiver attitudes towards pediatric COVID-19 vaccination have not been adequately classified or described. A better understanding of how caregiver attitudes influence household vaccination behavior can help tailor future vaccine interventions.

Methods

Unvaccinated children aged 18 months to 11 years underwent antibody testing and their caregivers were asked to complete an electronic survey at four clinic-based practices in Northern and Central NJ from September 2022 to April 2023. Information was collected on household exposures, vaccination status, COVID-19 infection, and caregiver beliefs about pediatric vaccination. Latent class analyses were conducted to group caregivers into four distinct profiles based on how safe, effective, useful and necessary they felt vaccination was.

Results

A total of 656 survey participants were grouped into a vaccine acceptance class based on their level of agreement on each attitudinal item, from low to high. Those in Class 1 had the most disagreement and lowest vaccine acceptance; those in Class 4 had the most agreement and highest vaccine acceptance. The majority of the sample fit into Class 2 (39%), indicating moderate disagreement and low COVID-19 vaccine acceptance.

Caregivers in the lowest vaccine acceptance classes (1 & 2) were significantly less likely to plan to vaccinate their children compared to those in higher classes (3 & 4); (9.8% and 5.5% vs. 31.9% and 61%).

Those in Class 2 were significantly less likely to have at least one adult household member fully vaccinated or boosted against COVID-19 than those in higher classes; and were significantly more likely to be from households where at least one adult was diagnosed with COVID in the past year than those in Class 3 (54.2% vs 37.7%).

Conclusion

Caregiver attitudes towards vaccination, and inclusion in vaccine acceptance classes, is closely associated with household vaccination status and COVID-19 infection history. Educational efforts and messaging should target the different aspects of caregiver profiles to address vaccine hesitancy and make future vaccine programming for children more successful.

Disclosures

Joseph V. Schwab, MD, MPH, Bristol-Myers Squibb: Stocks/Bonds|GE Healthcare: Stocks/Bonds|Johnson and Johnson: Stocks/Bonds
1730. Increasing Vaccination Rates of 23-valent Pneumococcal Polysaccharide Vaccine Among Patients at High-Risk for Invasive Pneumococcal Disease
Authors: Lyon Edward , Wetzel Tracey , Wirtz Ann , Swanson Doug , Moran Rachel R , Peters Jessica , Symes Christine A , Olarte Liset , El Feghaly Rana E
Published: November 2023

Background

Pneumococcal disease causes significant morbidity and mortality in children. Routine childhood immunizations protect for 13 or 15 pneumococcal serotypes via two pneumococcal conjugated vaccines. Patients with immunocompromising and chronic medical conditions are at high risk of invasive pneumococcal disease. A 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended in these patients to protect against more pneumococcal serotypes, but many patients have not received it. Our AIM is to increase PPSV23 vaccination rates among eligible patients in both the inpatient and outpatient infectious diseases (ID) settings from a baseline of 44% to 55% by October 2024.

Methods

In collaboration with Children’s Mercy integrated care solutions, we created a report of eligible patients evaluated by ID in the inpatient and outpatient settings. This report captures pneumococcal immunization history of patients eligible for PPSV23. In October 2022, we formed a multi-disciplinary team of ID nurses, a pharmacist, providers, and a patient advocate. We identified several potential causes of low PPSV23 vaccination rate and developed countermeasures (figure 1). Since October 2022, we have discussed the project weekly during our divisional huddle. In January 2023, we matched outpatient and inpatient reports to include maximal information and created a 2-way communication strategy where outpatient nursing staff notifies ID providers of patients who qualify for PPSV23. In February 2023, we created an EMR shared phrase to include in ID provider notes and a badge buddy with qualifying conditions for PPSV23 vaccination.

Results

Following the initiation of the project we have seen an increase in qualifying patients who have received PPSV23 that has so far been sustained for 6 months (48-56%); we also see narrowing of the control limits implying improved process (figure 2).

Conclusion

We were able to increase PPSV23 vaccination of eligible high-risk patients in both the outpatient and inpatient settings. If this trend is sustained, we will be able to move our center line in 2 months. We have multiple additional plan-do-study-act cycles planned over the next several months to include electronic medical record changes, collaboration with different specialties and family education.

Disclosures

Doug Swanson, MD, Merck: Grant/Research Support|Sanofi: Grant/Research Support Liset Olarte, MD, MSc, GSK: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi: Grant/Research Support
1735. Impact of Children Universal Pneumococcal Vaccination (PCV7v/PCV13v) on Pneumococcal Invasive Disease Hospitalizations in a Private General Hospital, Uruguay
Authors: Sanchez-Varela Mercecedes , Chirella Marcelo , Varela Adriana , Algorta Gabriela , Facal Jorge , Pírez María Catalina
Published: November 2023

Background

In 2008 Uruguay included pneumococcal conjugate vaccine (PCV) 7valent in children´s vaccination program (2+1). In 2010 PCV13 replaced PCV7. Since 2015, adults at risk of invasive pneumococcal disease (IPD) may receive 23 valent polysaccharide vaccine (PV23) or combined schedule PCV13+PV23.

Objective: to assess the impact of this strategy on IPD hospitalization.

Methods

Rates per 10,000 discharges (Confidence Interval 95 %), diseases and serotypes (ST) are described before PCV7 vaccination (2006-2007), the year of vaccine implementation (2008), early after implementation (2009-2015) and late after implementation (2016-2022), the last 3 years during COVID-19 pandemic.

Results

In 2006-2022 were 33 IPD cases in children and 88 in adults over 15 years old. Children´s hospitalization median annual rates were as follow 2006-2007: 50 (25-75); 2008: 18,5 (-2-39); 2009-2015: 8,5 (3-14); 2016-2022: 4 (0-8); percentages of rate reduction were 82,5% and 92% (p< 0.0000). In adults 2006-2007: 17 (10-25); 2008: 13,4 (4,62-22,1); 2009-2015: 6,6 (4,4-9); 2016-2022: 6 (3,5-8,5); percentages of rate reduction were 63,5% and 66 % (p= 0,0001).

Pneumococcal pneumonia (PP) was the most frequent disease in children 22/33 (66,6%), followed by bacteremia 8/32. PP was also in adults 68/88 (77.2,7%), followed by meningitis (7/88). One non vaccinated child died in 2008. Case fatality rate in adults was 9% (8/88), 3 died in 2006-2007, 2 in 2009-20215 and 3 in 2016-2022.

24 different ST were isolated in adults. Most frequent ST were 12F(15), 7F(11), 1(8), 8(7), 3(6) and 5(6). PCV13 would cover 38/88 (43%). A significant decline in PCV13 serotypes (PCV13-ST) was observed comparing the period prior PCV 17/22 (77%) with the late period 8/24 (34%) (p< 0.0000).

15 different ST were isolated in children: 26 PCV13-ST. 16 prior 2008: most frequent ST 1(5), 14(4), 3(2) and 5(2). In 2009-2022 13 hospitalizations; PCV13-ST: 1(2), 19A(2), 14(1), 6B< (1), 9V(1), 3(1) and non PCV13-ST: 7B/C(1), 24F(1), 13(1), 15A(1), 15B(1). A significant decline of PCV13-ST was observed comparing the period prior PCV (15/16, 94%) with the late period (2/4, 50 %) (p< 0.0000).

Conclusion

There was a reduction in children’s discharge rates and in adults´ probably due to herd effect. Adult vaccination will improve individual immunization.

Disclosures

María Catalina Pírez, Pediatrician, Pediatric infectologist, microbiologist Professor of pediatric, Degree V, Merck, Pfizer: Expert Testimony|Merck, Pfizer: Honoraria
1746. RSV seasonality patterns change during 2016 to 2020 among hospitalized young children in Taiwan
Authors: Chung Ching-Hu , Tsai Szu-Ying , Yeh Ting-Yu
Published: November 2023

Background

Respiratory syncytial virus (RSV) is a common cause of hospitalizations in young children. Previous studies in Taiwan demonstrated seasonality of RSV hospitalization (RSVH) in young children was rather year-round with small peaks in spring and fall. This study aims to investigate recent seasonality patterns of RSVH in Taiwan using latest National Health Insurance (NHI) database.

Methods

We linked Taiwan birth cohort database to the NHI database for the years 2016-2020. Children < 5 years having hospital admission record with RSV ICD-10 coding were defined as having RSVH. To assess the correlations between RSVH with monthly average temperature/humidity, we used data from 2016-2019 (not including 2020 due to unusual RSV endemic) and by geographic region (Northern, Central, and Southern Taiwan).

Results

In children < 1 year, the annual RSVH incidence increased steadily from 1.32% in 2016, 1.55% in 2017, 1.60% in 2018, 1.67% in 2019, to 1.71% in 2020 (p=0.03). In contrast, for children aged 1-4 years, the annual RSVH incidence remained somewhat stable from 0.29%, 0.33%, 0.36%, 0.31% from 2016 to 2019, then substantially increased to 0.76% in 2020 (a 2.47-fold increase compared to 2019, p=0.22). Only one RSVH peak was observed per year for both age groups: in May for 2016, September for 2017-2019 and November for 2020. Temperature and RSVH showed high correlation among years 2016-2019, with correlation coefficients 0.64-0.68 and 0.64-0.66 in children aged < 1 and 1-4 years, respectively. However, RSVH only showed low to moderate correlation with humidity in both age groups.

Conclusion

The previously established seasonality patterns of RSVH in Taiwan were disrupted. A higher RSVH incidence for children aged 1-4 years was noted during 2020 endemic than previous years. Only one RSVH peak was observed in 2016-2020, and its correlation with temperature was high.

Disclosures

Ching-Hu Chung, PhD, Sanofi and AstraZeneca: Grant/Research Support Szu-Ying Tsai, n/a, Sanofi: employe Ting-Yu Yeh, n/a, Sanofi: employe
1748. Viral and Bacterial Etiology of Acute Gastroenteritis in Children < 5 Years Old at a Major Pediatric Referral Center Before and During the COVID-19 Pandemic
Authors: Hamdan Olla , Stopczynski Tess , Amarin Justin Z , Qwaider Yasmeen Z , Hayek Haya , Stewart Laura S , McHenry Rendie , Spieker Andrew J , Chappell James , Wikswo Mary , Mirza Sara , Halasa Natasha B
Published: November 2023

Background

In the United States, acute gastroenteritis (AGE) accounts for 1.5 million office visits, 200,000 hospitalizations, and 300 deaths in children each year. The specific etiology of AGE often remains unknown due to limited testing, including before and during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

We analyzed data collected in the emergency department (ED) and inpatient (IP) settings at Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center as part of the CDC New Vaccine Surveillance Network (NVSN); a prospective population-based AGE surveillance study. Our analysis included children < 5 years of age presenting with vomiting (≥ 1 episode within 24 hours) or diarrhea (≥ 3 episodes within 24 hours) within 10 days prior to presentation and had a research stool specimen tested using xTAG® Gastrointestinal Pathogen Panel (Luminex). Our analysis included children with either bacterial or viral detection. Clostridioides difficile in children < 2 years of age was considered a colonization.

Results

A total of 1,078 children with AGE were enrolled in the ED or IP from 01/12/2016 to 01/31/2023 and had a stool sample tested. We excluded 35 children with viral and bacterial co-detection and those with parasite detection. Our final analysis included 1,043 children with either viral detection (n=336, 32%), bacterial detection (n=70, 7%), or no detection (n=637, 61%). Notably, the viral group was younger and more likely to present with vomiting compared to the bacterial group (Table 1). The most frequently detected viral pathogen was norovirus, followed by rotavirus, and then adenovirus. Salmonella was the commonly detected bacterial enteropathogen, followed by Clostridioides difficile. Most cases occurred in the pre-pandemic period, with negligible AGE cases reported from April to December 2020. However, AGE cases re-emerged in 2021 (Figure 1). A higher proportion of bacterial pathogens were detected during the COVID-19 pandemic.Table 1.Demographic and clinical characteristics of children <5 years old who had a stool sample tested by xTAG® Gastrointestinal Pathogen Panel (N=1,043).Figure 1.Monthly detection of viral (a) and bacterial (b) AGE pathogens from December 2016 to January 2023.

Conclusion

Viral pathogens remained the predominant etiology of AGE in young children during the COVID-19 pandemic. Reduction of AGE cases likely coincided with stay-at-home recommendations utilized and less gathering opportunities during the COVID-19 pandemic.

Disclosures

Natasha B. Halasa, MD, MPH, Merck: Grant/Research Support|Quidell: Grant/Research Support|Quidell: donation of kits|Sanofi: Grant/Research Support|Sanofi: vaccine support
1761. What Makes Black and Mexican American Children More Vulnerable than White Children to Upper Respiratory Infection?
Authors: Bhavnani Darlene , Dunphy Peter , Matsui Elizabeth
Published: November 2023

Background

There is excess risk of upper respiratory infection (URI) among Black and Mexican American children in the US. Evidence suggests that obesity and exposure to nicotine may impair host-pathogen defense mechanisms, increasing susceptibility to URI. Low socioeconomic status (SES) is also linked to a higher risk of URI. Obesity, nicotine exposure, and low SES are more prevalent in racial and ethnic minority populations. We evaluated the extent to which these factors explain the association between race/ethnicity and URI. We also evaluated whether the relationships between these potential risk factors and URI differ by race/ethnicity.

Methods

Children 6-18 years of age from the National Health and Nutritional Examination Survey (2007-2012) were studied. Survey-weighted logistic regression models were used to estimate the association of self-reported cold (URI, defined as cough, cold, phlegm, runny nose, or other respiratory illness (excluding hay fever and allergies) in the past 7 days) to race/ethnicity. Models were adjusted for age and sex. Children with a sex- and age-specific BMI in the 95th percentile or higher were categorized as obese. Serum cotinine levels were used as a biomarker of nicotine exposure. Household SES was analyzed as a summative score which reflected income poverty ratio, home ownership, education, and health insurance.

Results

Black and Mexican American children had 1.34 (95% CI = 1.08-1.67) and 1.53 (95% CI = 1.20- 1.93) times the odds of a URI than White children. Accounting for obesity, serum cotinine, or SES did not attenuate associations between racial and ethnic identity and URI. There were no significant differences in the associations between serum cotinine or SES and URI by race/ethnicity. Associations between obesity and URI were attenuated in Black compared to White children.

Conclusion

Obesity, serum cotinine, and household SES do not help to explain why Black and Mexican American children are at greater risk of a URI than White children. Other contextual factors should be examined to identify the factors that place Black and Mexican American children at greater risk of URI.

Disclosures

All Authors: No reported disclosures
1762. Clinical application of handheld ultrasound devices during the 2022 Sudan Virus disease Ebola outbreak in Uganda
Authors: Kayiira Mubaraka , Wailagala Abdullah , Nalikkla Jacqueline , Kemigisha Stacy M , Okello Stephen , Migisha Isabella H , Muhindo Brenda , Katusabe Faith , Asiimwe Moses , Kyomuhendo Kiconco , Kobugabo Rosette , Kibuuka Hannah , Waitt Peter , Lamorde Mohammed , Clark Danielle , Blair Paul W
Published: November 2023

Background

The fluid status and causes of respiratory failure in patients with Ebola disease can be challenging to determine due to concomitant severe diarrhea, vascular leakage, and multiorgan failure. Point-of-care ultrasound (POCUS) could guide fluid resuscitation for patients in resource-limited settings. We present the clinical application of POCUS in the 2022 Sudan Virus disease Ebola outbreak in Uganda.

Figure.

Ultrasound findings from patient 2. 2A: Discrete B lines observed with an irregular pleural line; 2B: Inferior vena cava collapsibility <50% suggestive of adequate fluid resuscitation; 2C: parasternal short cardiac view with small pericardial effusion identified; 2D: apical cardiac view with small pericardial effusion redemonstrated.

Methods

A clinical research team in Fort Portal, Uganda was trained in advanced Infection Prevention and Control (IPC) to care for patients with Ebola disease and in POCUS for septic shock. The clinical team learned a standardized lung and cardiac critical care ultrasound approach to evaluate patients in septic shock. The scanning procedure was used during the care of 6 patients with confirmed Sudan virus disease within 2 weeks of outbreak declaration to make critical patient care decisions like fluid management. Chest X-ray services and mechanical ventilation were not accessible. A handheld Philips Lumify device was kept in the biocontainment area and was used in full personal protective equipment. Scanning procedures included 12-zone lung ultrasound and 4-view cardiac ultrasound scans to determine causes of respiratory disease and evaluate fluid status.

Results

Among 6 patients (age range 27 to 58 years; 1/6 female), 5/6 were in their third week of illness, and 1/6 was in his second week of illness. Lung ultrasound abnormalities included discrete B-lines (5/6 patients), confluent B-lines (1/6), irregular pleural lines (3/6 patients), and subpleural consolidations (1/6 patients). Two participants in respiratory distress had cardiac POCUS. Both had hyperdynamic left ventricular function and one had a small pericardial effusion (Figure). One patient had inferior vena cava (IVC) collapsibility < 50% (1.5 cm diameter), and another with a >50% IVC collapsibility (1.3 cm diameter). These findings contributed to a decision to continue fluid resuscitation.

Conclusion

Portable handheld ultrasound devices identified previously undescribed ultrasound features of Sudan virus disease. POCUS helped determine causes of respiratory failure and guided fluid resuscitation in a biocontainment ward without access to mechanical ventilation.

Disclosures

All Authors: No reported disclosures