240. Antibiotic Overuse Among Children with COVID-19 Hospitalized in a Pediatric Intensive Care Unit. (15th December 2022)

• Record Type: Journal Article
• Authors: Gillon, Jessica; Garguilo, Kathryn; LeBlanc, Kerry; Banerjee, Ritu
• Is Part Of: Open forum infectious diseases. Volume 9:(2022)Supplement 2
• Publication Date: 2022-12-15
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac492.318
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Antibiotic overuse has been well described among hospitalized adults with COVID-19 but similar evaluations in children are lacking. We sought to quantify bacterial infection rates and antibiotic utilization among critically ill children hospitalized with COVID-19 to identify opportunities to optimize care. Methods: We performed a single center retrospective cohort study of all children hospitalized with symptomatic COVID-19 in a pediatric intensive care unit between May 16, 2020 and February 11, 2022 at a tertiary care children's hospital in the Southeastern U.S. We performed medical record review to abstract demographic and clinical characteristics. This study was approved by the institutional IRB with a waiver of consent. Results: During the study period there were 92 subjects hospitalized in the intensive care unit with COVID-19. Demographic and clinical characteristics of the cohort are summarized in the Table . Median age was 12.4 years, median length of stay was 6 days, 32% of subjects required mechanical ventilation and 5% died. The vast majority of children had one or more comorbidities and only 1 subject was fully vaccinated against SARS-CoV-2. Thirteen (14%) subjects had bacterial growth from any clinical specimen. Eight subjects had respiratory cultures that may have represented airway colonization; when these were excluded, 5 (5%) subjects had either urinary tract or bloodstream infections. Two of the bloodstream infections were caused by drug-resistant organisms and were hospital-acquired. Despite the low number of subjects with bacterial infections, 45% received antibiotics for >3 days. The antibiotic days of therapy per subject varied widely and ranged from 0 to 61 days. Conclusion: In this cohort of nearly 100 critically ill children with COVID-19, the rate of culture-confirmed bacterial infection ranged from 5-14% yet nearly half of patients received antibiotics. Limitations include the single center and retrospective study design and the fact that bacterial pneumonia may not be culture-confirmed. Despite these limitations, this work suggests that children with COVID-19 rarely have bacterial co-infections and are often prescribed unnecessary antibiotics. Disclosures: All Authors : No reported disclosures.