299 - Paediatric Collaborative Network on Infections in Canada (PICNIC) Study of the Current Landscape of Gram Negative Bacteremias

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Presenting Author(s)

AL

Alice X. Lu

cMD
McMaster University
Hamilton, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

KT

Kara Tsang

Ms.
McMaster University
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MB

Michelle Barton

Pediatric Infectious Diseases Specialist
Children’s Hospital at London Health Centre
London, ON, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CF

Craig Frankel

Dr Craig Frankel
Western University
London, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JM

Jane McDonald

Pediatric Infectious Diseases Specialist
Montreal Children's Hospital
Montreal, QC, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JB

Jennifer Bowes

Research Coordinator
Children's Hospital of Eastern Ontario
Ottawa, ON, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JG

John Gunawan

Dr John Gunawan
University of Alberta
Edmonton, Alberta, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SF

Sergio Fanella

Associate Professor
University of Manitoba
Winnipeg, MB, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MA

Mohammad Alghounaim

Pediatric ID specialist and medical microbiologist
Department of Pediatrics, Amiri Hospital, Ministry of Health, Kuwait
Kuwait City, Al Asimah, Kuwait
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JC

Jeannette Coumeau

Dr J Comeau
Dalhousie University
Halifax, Nova Scotia, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KL

Kirk Leifso

Dr Kirk Leifso
Queen's University
Kingston, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RS

Robert Slinger

Pediatric Infectious Diseases Specialist
Children's Hospital of Eastern Ontario
Ottawa, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JR

Joan Robinson

Pediatric Infectious Diseases Specialist
Stollery Children's Hospital
Edmonton, AB, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SK

Sarah Khan

Assistant Professor, Associate Medical Director Infection Prevention and Control
McMaster University, Hamilton, Ontario, Canada
Hamilton, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Antimicrobial resistance is a public health threat, invasive infection from multi-drug resistant gram-negative (MDRGN) pathogens is associated with significant morbidity and mortality. The incidence of MDRGN bacteremia in Canada is rising, and pediatric data is limited.

Methods: This retrospective chart review of paediatric patients with gram negative bacteremia in a multicenter PICNIC database (n=7 centers) from 2013 to 2017. MDRGN was defined as enterobacteriaceae that were resistant to third generation cephalosporins (including ESBL, CPE). Ethics approval was obtained at all sites, and data was entered into a secure REDCAP database, descriptive statistics are described herein.

Results:

Of the 676 bacteremia patients in the database, 214 (31.7%) were gram negative pathogens. E. coli was the most frequent pathogen (59.8%, of which 22 of 128 were MDR), followed by Klebsiella (31.8%, of which 9 of 68 were MDR). Of the 31 MDRGNs, 19 were ESBL, 1 was a CPE, and 11 were nonspecific mechanisms of resistance. There were no multidrug resistant Pseudomonas, Stenotrophomonas, or Acinetobacter. The majority of patient were less than 3 months of age (59.3%) and were male (58.8%). The majority had an underlying comorbid condition; hematoncologic diagnosis accounting for 14.5%. Length of stay varied from 1 to 742 days (mean 72, standard deviation 88). 11% required admission to ICU, 10% required removal of a intravascular catheter, 7% required a change in ventilation status, 2% requiring procedural source control, and there was an 8% mortality rate. Treatment duration greater than 14 days occurred in 123 patients (61% of patients).Table 1. Demographic and clinical data of cases.
Table 2. Isolated species and patterns of resistance.
Table 3. Complications in treatment due to infection.

Conclusion: This preliminary analysis of a multicenter review of pediatric gram negative bacteremias demonstrates a higher risk in neonates with comorbid conditions. A surprisingly prolonged treatment duration of greater than 14 days occurred in the majority of patients. Further analysis to assess factors associated with prolonged treatment durations, MDR infection, and complications is required. Gram negative bacteremia remains a significant cause of morbidity and mortality in pediatric patients.