999. Ongoing Burden of Streptococcus pneumoniae Sepsis in Children After Introduction of Pneumococcal Conjuguate Vaccines

BACKGROUND: Recent population-based studies assessing the impact of pneumococcal conjugate vaccines (PCV) on the burden of pneumococcal sepsis in children are lacking. We aimed to define the burden of pneumococcal sepsis in children and assess predictors for severe outcomes following the introduction of PCV-13 in 2011 in a nationwide cohort study. METHODS: The Swiss Paediatric Sepsis Study prospectively recruited children <17 years of age with blood culture-proven sepsis between September 2011 and December 2015 in Switzerland. We report on patients with Streptococcus pneumoniae sepsis stratified by the presence of meningitis vs. any other clinical focus. Admission to the paediatric intensive care unit (PICU) and length ofhospital stay (LOS) were defined as outcomes. RESULTS: From all 1,181 sepsis episodes recorded during the 4.3-year period, children with pneumococcal sepsis (n = 117) accounted for 10% of all sepsis episodes, and 25% of community-acquired sepsis episodes. Forty-two (36%) patients required PICU admission resulting in a mortality of 8%. Children presenting with meningitis (29; 25%) were more frequently admitted to PICU (69% vs. 25%; P < 0.001) and more likely infected by serotypes not included in vaccines (69% vs. 31%; P < 0.001) than those without meningitis. Pneumococcal serotypes 3, 19A, and 7F accounted for 49 (44%) pneumococcal sepsis episodes. From 62 children completely immunised with PCV, of whom 32 were infected with vaccine serotypes, 16 (50%) presented with vaccine failure, of whom 11 were infected with serotype 3. In multivariable analyses, children with meningitis (OR 6.8; 95% C.I 2.4–19.3; P < 0.001) and those infected with serotype 3 (OR 2.8; 95% C.I 1.1- 7.3; P = 0.04) were more likely admitted to PICU, and those infected with serotype 3 had a longer hospital stay (β-coefficient 0.2, 95% CI 0.1–1.1; P = 0.01). CONCLUSION: The burden of pneumococcal sepsis in swiss children shortly after the introduction of PCV-13 remains important. Meningitis and serotype 3 were significant predictors of severity. DISCLOSURES: All authors: No reported disclosures.