Kelsey Wehrenberg, DO
Orlando Health - Arnold Palmer Hospital for Children
Milwaukee, Wisconsin
Disclosure information not submitted.
Michelle Mitchell, MD
Assistant Professor
Medical College of Wisconsin, United States
Disclosure information not submitted.
Tracy Zembles, PharmD
Pharmacist
Children's Wisconsin, United States
Disclosure information not submitted.
Ke Yan, PhD
Assistant Professor
Medical College of Wisconsin, United States
Disclosure information not submitted.
Liyun Zhang, MS
Biostatistician II
Medical College of Wisconsin, United States
Disclosure information not submitted.
Nathan Thompson, MD, PharmD
Associate Professor
Medical College of Wisconsin, United States
Disclosure information not submitted.
Title: Multidrug-Resistant Organism Acquisition After Treatment of Culture Negative Sepsis in Children
Introduction/Hypothesis: Multi-drug resistant organisms (MDROs) remain a serious public health threat. Pediatric intensive care unit (ICU) patients are particularly vulnerable to MDRO acquisition given their critical illness, immunosuppressed states, exposure to broad spectrum antibiotics, and prolonged hospital stays. In culture negative sepsis, patients often remain on broad spectrum antibiotics. This exposure may increase the risk of future MDRO infections.
Methods: This is a retrospective single center chart review of pediatric cardiac ICU patients treated for culture negative sepsis to assess for outcome variables including mortality, ICU length of stay, hospital length of stay, and subsequent new or worsening MDRO development. Patients received a minimum of 72 hours of antibiotics and only their first episode of culture negative sepsis in a single hospitalization were included. Patients admitted to the neonatal intensive care unit and those on prophylactic antibiotics for either extracorporeal membrane oxygenation (ECMO) or post-surgical management were excluded.
Results: Preliminary analysis of the first 20 patients demonstrated 10% of patients developed new or worsening MDRO following treatment of culture negative sepsis. Antibiotic treatment most often consisted of cefepime and vancomycin. Overall, patients treated for culture negative sepsis had 35% mortality of which 86% of patients died during their current sepsis event while the remaining 14% died in the 6-month follow-up period. The median and interquartile range (IQR) for PICU length of stay was 54.11 (13.63, 194.04) days and median (IQR) hospital length of stay was 99.74 (24.94, 227.13) days. In addition, out of the 20 patients, 85% of patients required vasoactive infusions, 45% had mechanical ventilation, and 10% were on ECMO with broadened antibiotic coverage.
Conclusions: Currently, there is very limited data regarding clinical outcomes and treatment of culture negative sepsis in the pediatric population. Given the high mortality rate and risk of development of new or worsening MDROs this disease process warrants further investigation with a larger patient population.