(194) Prescription Pattern of Empirical Antibiotic Used and The Factors Affecting Death in Children with Bacteremia in Taiwan

Publication Number: 1239

Background: Bacterial or fungal infection is a global health issue. With the frequent use of antibiotics, antibiotic resistance has become a major threat to human life, in addition to increasing the cost of medical care. The World Health Organization currently has data on adults only, and the data on antibiotic resistance in neonates or children remain insufficient.

Objectives: In order to comprehend, antibiotic prescription patterns and the epidemiology of antibiotic resistance among neonatal and childhood with bacteremia in Taiwan, we conducted a multi-center study in collaboration with four large teaching hospitals in northern, southern and eastern Taiwan.

Methods: Patients with aged 0~18 years and who admitted into hospital during from August 2017 to July 2019 were included. The laboratory, patient demographic, infectious episode, hospital occupancy and admissions, and antimicrobial prescription data were collected. The data source was queried by the medical record system of each hospital. To ensure the quality and consistency of data registration, we obtained registration accounts from the REDCap online login system and established an online sharing web page, which was recorded by well-trained clinical pharmacists at participating hospitals.

Results: Total of 3,844 patients were included, of which 101 (2.63%) had bacteremia. The mean age was 4.35 years, 45.54% were female, and the mean weight was 17.11 kg. 49.50% of them had complications, 36.63% were in the ICU ward, and 5.94% were using invasive ventilator. The most sources of infection were from bloodstream (49.50%), gastrointestinal tract (19.80%), respiratory tract (8.91%), and urogenital tract (8.91%). The most common pathogens were Escherichia coli (25.74%), Staphylococcus aureus (20.79%), and Salmonella (15.84%). In addition, 32.67% were treated with one antibiotic, and three patients (2.97%) did not receive empiric antibiotic therapy. The most commonly used antibiotics were penicillin (36.63%), aminoglycoside (36.63%), 3~4 generation cephalosporins (27.72%), and glycopeptides (26.73%). Pathogen-resistant were up to 10.31%. The highest resistant rate of pathogen to empirical antibiotics was Enterococcus faecium (50.00%), Streptococcus agalactiae (25.00%), and Candida spp. (19.67%). Total 7 patients died within 30 days, age (p=0.03) and whether admitted in the ICU ward (p < 0.001) were related with death within 30 days.

Conclusions: The most common pathogen in children with bacteremia were Escherichia coli, Staphylococcus aureus, and Salmonella. Resistant could be as high as 10.31%, in addition, the factors associated with death within 30 days of bacteremia children were young age and stay in the ICU ward.