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581. The Epidemiology of Imipenem-Resistant Acinetobacter baumannii Bacteremia in a Pediatric Intensive Care Unit and Carbapenem Use

BACKGROUND: Acinetobacter baumannii (AB) infections cause high mortality and morbidity in intensive care unit patients. There are limited data on the epidemiology of imipenem-resistant A. baumannii (IRAB) amongst pediatric ICU patients. METHODS: A retrospective chart review was performed in patients...

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Autores principales: Kim, Dongsub, Lee, Haejeong, Croney, Christina M, Sup Park, Ki, Jung Park, Hyo, Cho, Joongbum, Soo Ko, Kwan, Kim, Jinyeong, Son, Sohee, Choi, Joon-sik, Choi, Soo-Han, Huh, Heejae, Ryeon Chung, Doo, Yong Lee, Nam, Kim, Yae-Jean
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810977/
http://dx.doi.org/10.1093/ofid/ofz360.650
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author Kim, Dongsub
Lee, Haejeong
Croney, Christina M
Sup Park, Ki
Jung Park, Hyo
Cho, Joongbum
Soo Ko, Kwan
Kim, Jinyeong
Son, Sohee
Choi, Joon-sik
Choi, Soo-Han
Huh, Heejae
Ryeon Chung, Doo
Yong Lee, Nam
Kim, Yae-Jean
author_facet Kim, Dongsub
Lee, Haejeong
Croney, Christina M
Sup Park, Ki
Jung Park, Hyo
Cho, Joongbum
Soo Ko, Kwan
Kim, Jinyeong
Son, Sohee
Choi, Joon-sik
Choi, Soo-Han
Huh, Heejae
Ryeon Chung, Doo
Yong Lee, Nam
Kim, Yae-Jean
author_sort Kim, Dongsub
collection PubMed
description BACKGROUND: Acinetobacter baumannii (AB) infections cause high mortality and morbidity in intensive care unit patients. There are limited data on the epidemiology of imipenem-resistant A. baumannii (IRAB) amongst pediatric ICU patients. METHODS: A retrospective chart review was performed in patients with AB bacteremia in a pediatric intensive care unit at a tertiary teaching hospital from January 2000 to December 2016. Antimicrobial susceptibility tests, multilocus sequence typing (MLST) and PCR for antimicrobial resistance genes were performed for stored isolates. In addition, antibiotic prescription days of therapy (DOT per 1,000 patient-days) of the pediatric department from January 2001 to December 2016 was analyzed. RESULTS: Bacteremia episodes occurred in 27 patients. Male patients were 11 (41%) and the median age at the onset of bacteremia was 5.2 years (range, 0–18.6 years). There was a clear shift in antibiogram of AB during the study period. From 2000 to 2003, all isolates were imipenem-sensitive (ISAB, N = 6). From 2005 to 2008, both IRAB (N = 5) and ISAB (N = 4) were isolated. However, since 2009, all the AB isolates were IRAB (N = 12). In 33% (9/27) of patients, first AB was isolated from tracheal aspirate and patients developed bacteremia later (median duration from AB positive tracheal culture to AB positive blood culture, 8 days [range 5–124]). The overall mortality of patients with AB bacteremia was 59.3% (16/27) within 28 days. There was no statistical difference in mortality between ISAB and IRAB groups (50% vs. 71%; P = 0.42). From MLST analysis of 10 available isolates, sequence type 138 was predominant (N = 7). All 10 isolates were positive for OXA-23-like and OXA-51-like carbapenemase. In 2001, carbapenem DOT per 1,000 patient-days was 15.3 and later strikingly raised to 82.5 in 2009 when all the isolates were imipenem resistant. After this IRAB outbreak in PICU, proactive infection control and antimicrobial stewardship were reinforced among multidisciplinary teams in PICU. IRAB outbreak was terminated and carbapenem DOT per 1,000 patient-days was decreased to 51.7 in 2016. CONCLUSION: IRAB bacteremia causes serious threat in high-risk pediatric patients in PICU. Proactive infection control measures and antimicrobial stewardship are crucial to manage serious IRAB infection in PICU. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68109772019-10-28 581. The Epidemiology of Imipenem-Resistant Acinetobacter baumannii Bacteremia in a Pediatric Intensive Care Unit and Carbapenem Use Kim, Dongsub Lee, Haejeong Croney, Christina M Sup Park, Ki Jung Park, Hyo Cho, Joongbum Soo Ko, Kwan Kim, Jinyeong Son, Sohee Choi, Joon-sik Choi, Soo-Han Huh, Heejae Ryeon Chung, Doo Yong Lee, Nam Kim, Yae-Jean Open Forum Infect Dis Abstracts BACKGROUND: Acinetobacter baumannii (AB) infections cause high mortality and morbidity in intensive care unit patients. There are limited data on the epidemiology of imipenem-resistant A. baumannii (IRAB) amongst pediatric ICU patients. METHODS: A retrospective chart review was performed in patients with AB bacteremia in a pediatric intensive care unit at a tertiary teaching hospital from January 2000 to December 2016. Antimicrobial susceptibility tests, multilocus sequence typing (MLST) and PCR for antimicrobial resistance genes were performed for stored isolates. In addition, antibiotic prescription days of therapy (DOT per 1,000 patient-days) of the pediatric department from January 2001 to December 2016 was analyzed. RESULTS: Bacteremia episodes occurred in 27 patients. Male patients were 11 (41%) and the median age at the onset of bacteremia was 5.2 years (range, 0–18.6 years). There was a clear shift in antibiogram of AB during the study period. From 2000 to 2003, all isolates were imipenem-sensitive (ISAB, N = 6). From 2005 to 2008, both IRAB (N = 5) and ISAB (N = 4) were isolated. However, since 2009, all the AB isolates were IRAB (N = 12). In 33% (9/27) of patients, first AB was isolated from tracheal aspirate and patients developed bacteremia later (median duration from AB positive tracheal culture to AB positive blood culture, 8 days [range 5–124]). The overall mortality of patients with AB bacteremia was 59.3% (16/27) within 28 days. There was no statistical difference in mortality between ISAB and IRAB groups (50% vs. 71%; P = 0.42). From MLST analysis of 10 available isolates, sequence type 138 was predominant (N = 7). All 10 isolates were positive for OXA-23-like and OXA-51-like carbapenemase. In 2001, carbapenem DOT per 1,000 patient-days was 15.3 and later strikingly raised to 82.5 in 2009 when all the isolates were imipenem resistant. After this IRAB outbreak in PICU, proactive infection control and antimicrobial stewardship were reinforced among multidisciplinary teams in PICU. IRAB outbreak was terminated and carbapenem DOT per 1,000 patient-days was decreased to 51.7 in 2016. CONCLUSION: IRAB bacteremia causes serious threat in high-risk pediatric patients in PICU. Proactive infection control measures and antimicrobial stewardship are crucial to manage serious IRAB infection in PICU. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6810977/ http://dx.doi.org/10.1093/ofid/ofz360.650 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Kim, Dongsub
Lee, Haejeong
Croney, Christina M
Sup Park, Ki
Jung Park, Hyo
Cho, Joongbum
Soo Ko, Kwan
Kim, Jinyeong
Son, Sohee
Choi, Joon-sik
Choi, Soo-Han
Huh, Heejae
Ryeon Chung, Doo
Yong Lee, Nam
Kim, Yae-Jean
581. The Epidemiology of Imipenem-Resistant Acinetobacter baumannii Bacteremia in a Pediatric Intensive Care Unit and Carbapenem Use
title 581. The Epidemiology of Imipenem-Resistant Acinetobacter baumannii Bacteremia in a Pediatric Intensive Care Unit and Carbapenem Use
title_full 581. The Epidemiology of Imipenem-Resistant Acinetobacter baumannii Bacteremia in a Pediatric Intensive Care Unit and Carbapenem Use
title_fullStr 581. The Epidemiology of Imipenem-Resistant Acinetobacter baumannii Bacteremia in a Pediatric Intensive Care Unit and Carbapenem Use
title_full_unstemmed 581. The Epidemiology of Imipenem-Resistant Acinetobacter baumannii Bacteremia in a Pediatric Intensive Care Unit and Carbapenem Use
title_short 581. The Epidemiology of Imipenem-Resistant Acinetobacter baumannii Bacteremia in a Pediatric Intensive Care Unit and Carbapenem Use
title_sort 581. the epidemiology of imipenem-resistant acinetobacter baumannii bacteremia in a pediatric intensive care unit and carbapenem use
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810977/
http://dx.doi.org/10.1093/ofid/ofz360.650
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