P0583 - Epidemiology of Central Line-Associated Bloodstream Infections and Empiric Use of Antibiotics among Pediatric Patients

TITLE: Epidemiology of Central Line-Associated Bloodstream Infections and Empiric Use of Antibiotics among Pediatric Patients in the Children’s Hospital of Illinois

Background: Central Line-Associated Blood Stream Infections (CLABSI) are the most common healthcare-associated infections in children with comorbidities. The prevalence of Multi-Drug Resistant Organisms MDRO causing CLABSI is rising rapidly worldwide, resulting in a worsening of morbidity and mortality. Information about the prevalence of CLABSI due to MDRO among children, their risk factors, and patterns of empiric antibiotic use is limited.

Objective: To identify the microbiologic etiology of CLABSI, assess the percentage and risk factors of MDRO, and evaluate the empiric antibiotic use in the same population.
Design/

Methods: A retrospective study was conducted. We reviewed the charts of all patients aged 0-18-year-old diagnosed with CLABSI, as per CDC surveillance criteria, who were admitted to the NICU, PICU, Hem/Onc, and pediatric unit between Jan 2013 to Dec 2018.

Results: In our study, 59 episodes of CLABSI were identified. The prevalence of MDRO was 8.4% (n=5) among all infections. Gram-positive micro-organisms were identified in 50% of cases (n=30) while gram-negative micro-organisms were identified in 37% of cases (n=22). Candida species contributed to 12% of all CLABSI (n=7). Staph coagulase-negative predominated among all gram-positive infections (n= 12) and was isolated mostly in the NICU and PICU. E. coli constituted the majority of gram-negative bacteria (n=6). No significant difference was identified in the predictors of MDRO versus non MDRO infections among pediatric patients (P=0.1). Empiric use of ampicillin was documented exclusively in the NICU in 25.4% (n=15) of all cases of CLABSI (P= 0.002). Empiric use of vancomycin plus cefepime or ceftriaxone/cefotaxime was documented in most of the units with a higher rate of use in the PICU.
Conclusion(s): The use of ampicillin as an empiric treatment for CLABSI in the NICU is inappropriate. A combination of vancomycin and third/or fourth-generation cephalosporins is the best empiric approach to target the isolated microorganisms that cause CLABSI in our institution.