1527. Clinical Variables Associated with Vancomycin Resistance in Children with Bacteremia Due to Enterococcus spp.

Abstract

Background Enterococcus spp. (E) is an important cause of nosocomial bacteremia. The emergence of vancomycin-resistant E in the nosocomial setting conditions the empirical treatment and limits therapeutic options.MethodsA retrospective cohort study of children ≥1 month with E bacteremia in a reference pediatric hospital was performed. Study period January 1, 2016–December 31, 2018. Outcome: to describe clinical and epidemiological characteristics of children with bacteremia due to Enterococcus spp. resistant to vancomycin (VRE) vs. sensitive (VSE). Identify variables associated with VRE. STATA 13 was used.Results N = 82 patients. Median age was 37.6 months (IQR 2–48), 45 patients (54.9%) were male; 76 patients (92.7%) had underlying disease (intestinal failure (21.9%), heart disease (17.1%), preterm births (12.2%), hematological disease (10.9%), and liver failure (7.3%); 16 patients (19.5%) received immunosuppressive therapy. Sixty bacteremia (73.2%) were by E. faecalis and 22 (26, 8%) by E. faecium. Vancomycin resistance was documented in 13 patients (15.8%), all of which were E. faecium. In the bivariate analysis, patients with VRE bacteremia were significantly older in months than those with VSE bacteremia [75.4 (IQR 6–151) vs. 30.5 (IQR 2–33), P <0.02]; had more frequency of previous colonization with VRE [n: 8 (61.5%) vs. n: 4 (5.8%) P < 0.001], hematological disease [n: 5 (38.5%) vs. n: 5 (5.8%), P = 0.01], liver failure [n: 3 (23.1%) vs. n: 3 (4.4%), P = 0.02] and immunosuppressive therapy [n: 6 (46.2%) vs. n: 10 (14.5%) P = 0.008]. Patients with VRE bacteremia had a lower median white blood cell count [7040 (IQR 2150–10250) vs. 14474 (IQR 6160–17090), P <0.03]. Mortality in P with VRE was 15.4% (n: 2) and 4.3% in P with VSE (n: 3), P = 0.1. No statistically significant differences were found according to history of surgery, previous hospitalization, antibiotic therapy in the last 3 months or clinical presentation. In the multivariate model, predictors of VRE bacteremia adjusted for the rest of the significant variables were hematological disease OR 11.1 (95% CI 2.3–53.8) P = 0.003, and liver failure OR 7.7 (95% CI 1.2–50.4), P = 0.03.ConclusionIn this cohort of children with enterococcal bacteremia, hematological disease and liver failure were predictive variables of VRE bacteremia.Disclosures All authors: No reported disclosures.