PC1217: Reduction of Inpatient Antibiotic Treatment for Infants Admitted for Sepsis Evaluation and Found to Have a Viral Infection

Purpose/Objectives: The management approach to febrile infants remains challenging. Despite new advances in rapid diagnostic testing, febrile infants with a viral infection could receive prolonged antimicrobial treatment due to concerns for co-existing serious bacterial infection (SBI).
We sought to decrease the duration of antibiotic treatment in febrile infants less than 8 weeks of age hospitalized on an inpatient infectious diseases service following sepsis evaluation, who have enterovirus, parechovirus, or respiratory viruses detected, from an average 26.2 hours to 24 hours or less and sustain for one year.

Design/Methods: A divisional management guideline that defined “low-risk” infant, inclusion and exclusion criteria was created. An application (QlikSense) was created for further clinical characterization of patients and follow-up. Guideline was adopted by all infectious diseases faculty. Pre-study baseline period was January 2017 to April 2019 and study period was May 2019 to December 2021. Patients with identified SBI, localized infections, patients treated for bronchiolitis, infants with gestational age < 36 weeks, infants with HSV and SARS-2 infection were excluded. Respiratory viruses were detected by a multiplex PCR assay (Biofire). In-house PCRs for HSV, entero- and parechoviruses for superficial sites and a meningitis encephalitis infection array (Biofire) for CSF were used. Positive bacterial culture results and readmission data were followed. Control charts were used to assess the impact of the interventions.

Results: 1160 infants were admitted with fever and diagnosed viral infection. After exclusions, 160 infants were included in the final study/intervention group. 315 infants were evaluated in the pre-intervention group. When this group is evaluated for their antibiotic duration, the results showed further improvement for the duration to antimicrobial treatment with a mean of 19.4 hours from 26.2 hours (p < 0.001). Admissions of febrile infants with viral infections decreased in 2020 and 2021 during the COVID-19 pandemic.
SBIs were infrequent in all patients with an identified viral infection. There was a statistically significant difference in the length of stay from 41.4 hours to 39.1 hours during the study period (p = 0.0062). No significant difference in 30-day readmission rates was observed. There was no reported readmission for SBI. 1.7% of infants had SBI identified.

Conclusion/Discussion: Over a period of two years, we showed significant and sustainable decrease in antibiotic treatment duration and length of stay in our patient population. Antibiotic treatment can safely be discontinued in clinically stable infants with a documented viral infection after 24 hours of negative blood, CSF, and urine bacterial cultures so as not to subject them to unnecessary prolonged inpatient treatment that could increase side effects.
Decreased treatment side effects and treatment costs were additional possible improvements.