1153. ESBL Producing E. coli Urinary Tract Infections in Children: Is Carbapenem Always Necessary?

Abstract Background Urinary tract infections (UTI) are common in children with a prevalence of 5% in infants. UTI are the main reason for beginning antibiotics in children’s hospitals and E. coli is approximate 80% of urinary pathogens. Extended-spectrum beta-lactamases (ESBL) producing E. coli are a common concern in daily practice. Carbapenems, especially ertapenem are the choice for the treatment in some hospitals, but aminoglycosides or trimethoprim and sulfamethoxazole are options for carbapenem saver. The aim of this study was comparing the clinical outputs in ESBL producing E. coli ITU in children treated with ertapenem or amikacin. Methods We designed a quasi-experimental study. In 2018 the antimicrobial stewardship program begins the use of amikacin for non-septic UTI for ESBL producing E. coli. Before this recommendation the use of ertapenem was common. We use WHONET 5.6 to identify ESBL producing E. coli UTI between 2016 and 2020. We analyzed the information using R 4.0.3. Results We analyzed 162 clinical records. 89 in ertapenem group, 45 in amikacin group, 23 in other treatments (TMP-SMX, meropenem) and 5 patients that received empirical treatment (Cefazolin) with clinical improvement and ambulatory management. The initial clinical and paraclinical variables was similar between two groups, only meropenem was more frequent in amikacin group as empiric treatment (table 1). Amikacin group received for media 7.4 days of antibiotic therapy (IQR 7-7.5) and ertapenem 8.2 days (IQR 7-10) (p value 0.049). The mortality, PICU requirement, mechanical ventilation and inotropic requirement was similar an both groups (Table 2). In amikacin group the median length of stay was 7.2 days (IQR 4-9) and in ertapenem group was 9 days (IQR 6-10). No significant adverse effects were documented in any group. Table 1. Patient’s characteristics in both groups. Table 2. Patient’s Clinical outcomes in both groups Conclusion The use of amikacin in ESBL producing E. coli UTI in children have similar clinical outputs that ertapenem. The use of amikacin could decrease de hospitalization time. Disclosures Ivan Felipe Gutiérrez Tobar, n/a, Pfizer and MSD (Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau, Has received support from Pfizer and MSD for participation in congresses and has received conference payments from Pfizer)Pfizer and MSD (Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses)

Background. Persistent Staphylococcus aureus bacteremia (pSAB) is a poorly defined entity, but associated with significant morbidity and mortality in children. We aim to better describe the epidemiological features of this clinical entity.
Methods. We performed a retrospective case series analysis of pediatric patients with pSAB at a single center children's hospital using electronic medical data from 2016 -2020. Bacterial persistence was defined as culture growth > 72 hours after first blood culture.
Results. Twenty-two patients with pSAB were included in the analysis. Sources of persistent infection were endovascular infection (n=11, 50%), osteoarticular infection (n=6, 27%,), isolated central line associated blood stream (n=4, 18%), isolated skin and soft tissue infection (n=2, 9%), and no known primary infectious site (n=1). Methicillin resistance occurred in 41% (n=9) of cases of pSAB. Total duration of therapy varied, with a median of 4 weeks from negative cultures (range of 2 -8 weeks). Total days of positive cultures in pSAB were not significantly associated with methicillin susceptibility of the bacterial isolate, use of double gram-positive coverage, nor presence of a central venous catheter. Use of double gram-positive coverage occurred in 50% of cases with a mean duration of therapy of 11 days, most frequently in cases of septic thrombophlebitis (Table 1). Rifampin and gentamicin were the most commonly used agents. Conclusion. Children presenting with persistent S. aureus bacteremia present with a heterogenous group of underlying conditions and epidemiological features. While pediatric recommendations for double gram-positive coverage for synergy have not been established, their use for pSAB is common, especially in endovascular infections where culture persistence is often an expected outcome. Further research should examine risk factors for pSAB and define optimal treatment modalities and duration.
Disclosures. Background. Studies of pediatric neck infections demonstrate an increase in methicillin resistant Staphylococcus aureus (MRSA), and predominance of Staphylococcus aureus (S. aureus) in infants, and commonly polymicrobial infections. Thus, some providers treat acute neck infections with empiric broad spectrum antibiotics, often with two drugs. Our institution often uses clindamycin plus ampicillin-sulbactam as empiric therapy for hospitalized children with acute neck infection. We aimed to identify the microbiology of acute neck abscesses at our institution to determine if stratifying by age and abscess location would allow for single agent therapy.

Methods.
Diagnosis codes identified patients hospitalized with acute neck infections. Cases with underlying malignancy, cervicofacial malformations, or lymphatic malformations were excluded. Patients with surgical cultures were categorized into two groups based on anatomic location of infection: medial (retropharyngeal, parapharyngeal, and peritonsillar), lateral (other locations), or both. Within each group, causative pathogen(s) were explored and further categorized by age (infants: < 1 year old; non-infants: ≥1 year old).
Results. 412 patients were hospitalized for acute neck infection of which 132 had surgical cultures. 110 had growth of one or more pathogens (20 infants, 90 non-infants). 53 infections were located medially, 54 laterally, and 3 had both locations involved. S. aureus was most commonly identified, with lateral infections accounting for the majority (Table 1). 40/44 S. aureus isolates were susceptible to clindamycin. Among medial infections, Streptococcus Anginosus and Group A Streptococcus were most common followed by S. aureus (Table 1). 17/20 (85%) positive cultures in infants grew S. aureus with 8/17 (47%) MRSA. No polymicrobial infections were identified in infants. Among non-infants, 0/39 lateral infections had polymicrobial growth but 23/50 (46%) of medial infections did.
Conclusion. Local epidemiology based on anatomic location and patient age suggests a single agent (clindamycin for lateral and penicillin with beta-lactamase inhibitor for medial) may be reasonable for non-infants with uncomplicated neck infections. For infants, coverage of MRSA, regardless of anatomic location, is advisable.
Disclosures. All Authors: No reported disclosures S668 • OFID 2021:8 (Suppl 1) • Abstracts Extended-spectrum beta-lactamases (ESBL) producing E. coli are a common concern in daily practice. Carbapenems, especially ertapenem are the choice for the treatment in some hospitals, but aminoglycosides or trimethoprim and sulfamethoxazole are options for carbapenem saver. The aim of this study was comparing the clinical outputs in ESBL producing E. coli ITU in children treated with ertapenem or amikacin. Methods. We designed a quasi-experimental study. In 2018 the antimicrobial stewardship program begins the use of amikacin for non-septic UTI for ESBL producing E. coli. Before this recommendation the use of ertapenem was common. We use WHONET 5.6 to identify ESBL producing E. coli UTI between 2016 and 2020. We analyzed the information using R 4.0.3.
Results. We analyzed 162 clinical records. 89 in ertapenem group, 45 in amikacin group, 23 in other treatments (TMP-SMX, meropenem) and 5 patients that received empirical treatment (Cefazolin) with clinical improvement and ambulatory management. The initial clinical and paraclinical variables was similar between two groups, only meropenem was more frequent in amikacin group as empiric treatment (table 1). Amikacin group received for media 7.4 days of antibiotic therapy (IQR 7-7.5) and ertapenem 8.2 days (IQR 7-10) (p value 0.049). The mortality, PICU requirement, mechanical ventilation and inotropic requirement was similar an both groups (Table  2). In amikacin group the median length of stay was 7.2 days (IQR 4-9) and in ertapenem group was 9 days (IQR 6-10). No significant adverse effects were documented in any group.  Disclosures. Ivan Felipe Gutiérrez Tobar, n/a, Pfizer and MSD (Advisor or Review Panel member, Research Grant or Support, Speaker's Bureau, Has received support from Pfizer and MSD for participation in congresses and has received conference payments from Pfizer)Pfizer and MSD (Speaker's Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses)