1512. Treatment of Staphylococcus aureus Bacteremia in a Pediatric Population: A Retrospective Cohort Analysis

BACKGROUND: Staphylococcus aureus bacteremia (SAB) is a well-known cause of morbidity in pediatric patients; however, limited data are available regarding optimal antimicrobial therapy. The purpose of this study was to assess treatment outcomes associated with intravenous (IV) vs. oral (PO) stepdown treatment of SAB in a pediatric population. METHODS: This study evaluated patients who were admitted between July 2012 and August 2018, between the ages of 3 months and 18 years, had a blood culture positive for S. aureus, and received at least 72 hours of inpatient treatment. Exclusion criteria were as follows: pregnancy, death within 72 hours of initial culture, hospice/palliative care, polymicrobial bacteremia, and previous SAB within the study period. The primary endpoint was 30-day readmission rates. Secondary endpoints included hospital length of stay and all-cause inpatient mortality. RESULTS: In total, 101 patients were included (43 IV therapy alone; 58 PO stepdown). The median age was 7.9 years (IQR, 3.0, 12.2; range 4 months to 16.7 years), and 52.5% were male. The most common primary foci of infection were osteomyelitis (n = 32), device-associated infections (n = 23), and skin/soft-tissue infections (n = 8). Most patients (56.4%) had no comorbidities. There were no significant differences in comorbidities between groups except the IV group had significantly more immunosuppressed patients (30.2% vs. 1.7%; P < 0.001). Methicillin resistance was noted in 56.4% of patients (62.8% IV group vs. 51.7% PO stepdown; P = 0.313). The most common IV agents were vancomycin (n = 51) and anti-Staphylococcal penicillins (n = 21), while the most common PO agents were clindamycin (n = 29) and cephalexin (n = 20). Thirty-day readmission occurred in 25.6% (n = 10) of patients receiving full-course IV therapy and 5.3% (n = 3) in the PO stepdown group among survivors (P = 0.006; n = 96). Median length of stay was 11.0 days (IQR, 8.0, 21.0) in the IV group and 7.0 days (IQR, 5.0, 11.0) in the PO stepdown group (P = 0.001). All-cause inpatient mortality occurred in four patients (9.3%) in the IV group compared with one (1.7%) in the PO stepdown group (P = 0.160). CONCLUSION: Patients in the PO stepdown group had a low rate of 30-day readmissions and had a significantly shorter hospital length of stay than patients who received a full IV course. DISCLOSURES: All authors: No reported disclosures.