2341. Trends in Adenovirus Infections in Singapore Children and Outcomes of Cidofovir Treatment in the Severely Ill

Abstract

BackgroundAn increase in human adenovirus (HAdV) infections among hospitalized children in Singapore was observed since 2013. Cidofovir is often used to treat severe HAdV infections despite limited data. This study describes the epidemiology and outcomes of children with severe HAdV disease requiring high dependency (HD) or intensive care unit (ICU) admission in our hospital (KKH).MethodsThis is a retrospective cohort study of HAdV-infected children admitted to HD and ICU in KKH from January 2013 to September 2017. Characteristics and outcomes of those who received IV cidofovir was also reviewed.ResultsHAdV admissions and genotype profiles in KKH are described in Figures 1 and 2, respectively. There were 85 children with severe HAdV infection, of which 17 (20%) received cidofovir for mainly viremia (8, 47.1%) and pneumonia (7, 41.2%). Of these 17 patients, 7 (41.2%) died. More children treated with cidofovir had genotype 7 infection (8 of 17, 47.1%) vs. 13 of 68 (19.1%) who did not (P = 0.027). Characteristics of patients who received cidofovir are described in Table 1. None experienced adverse reactions from cidofovir. Table 1:Comparison of Characteristics of 17 Children Who Received IV CidofovirDischarged (N = 10)Death (N = 7) P ValueAge in years (median, IQR)2.6 (1.7–3.7)2.2 (1.2–5.9)0.922Male5 (50.0)6 (85.7)0.304Significant co-morbidities5 (50.0)6 (85.7)0.304Prematurity0 (0.0)1 (14.3)0.412Neurological1 (10.0)3 (42.9)0.250Cardiopulmonary0 (0.0)1 (14.3)0.412Immunodeficiency3 (30.0)1 (14.3)0.603Others1 (10.0)0 (0.0)1.000Disease presentationPneumonia1 (10.0)6 (85.7)0.004Gastroenteritis1 (10.0)0 (0.0)1.000Neutropenic sepsis0 (0.0)1 (14.3)0.412Viremia8 (80.0)0 (0.0)0.002Days of symptoms prior admission (median, IQR)6.5 (2.3–10.8)4.0 (0.0–5.0)0.350Adenovirus genotype 74 (40.0)4 (57.1)0.637Required ICU stay5 (50.0)7 (100.0)0.044Days to cidofovir (median, IQR)7.0 (1.5–25.8)12.0 (4.0–40.0)0.434Length of stay in days (median, IQR)21.5 (15.0–63.5)34.0 (16.0–43.0)0.696All are n (%) unless stated otherwise.ConclusionMore children with HAdV genotype 7 infection required cidofovir treatment. HAdV pneumonia and ICU admission are potential risk factors for mortality despite cidofovir treatment.Disclosures All authors: No reported disclosures.