P1591: HIGH RISK OF BLOOD STREAM INFECTION OF CRE CARRIERS IN NEUTROPENIC CHILDREN WITH HEMATOLOGICAL DISEASES

Abstract

Background: Neutropenic children with hematological diseases were associated with higher morbidity of carbapenem-resistant enterobacteriaceae (CRE) blood-stream infection (BSI) or colonization. Aims: We aimed to identify the clinical characteristics and clinical outcome caused by CRE-BSI. Methods: 2465 consecutive neutropenic children were enrolled. Antimicrobial susceptibility of CRE strains were explored and potential factors associated with subsequent CRE-BSI and 30-day survival probability were assessed. Results: CRE-carriers were identified in 59/2465 (2.39%) patients and19/59 (32.2%) developed CRE-BSI, while 12/2406 (0.5%) of non-carriers developed CRE-BSI (P<0.001). The 30-day survival probability was significantly lower in patients with CRE-BSI than non-BSI (73.9% vs. 94.9%, P=0.050). Moreover, 30-day survival probability was also poorer in CRE-carriers versus non-carriers (49.7% vs. 91.7%, P=0.048) among CRE-BSI patients. Tigecycline and amikacin exhibited the satisfactory antimicrobial activity against all isolated strains. Fluoroquinolone sensitivity was lower in E. coli (27.1%) versus satisfactory susceptibility of E. cloacae strains (93.1%). CRE-BSI accompanying intestinal mucosal damage were independent risk factors for 30-day survival probability (both P<0.05), while mucositis was also prone to developed CRE-BSI (P=0.034). Image:Summary/Conclusion: CRE-BSI was regarded as an independent predictor predisposing to high mortality in neutropenic children. Moreover, individualized antimicrobial therapy should be adopted due to the different features of patients with separate CRE strains.