Clinical Characteristics of Hospitalized COVID-19 in Children: Report From the COVID-19 Registry in Japan

A total of 1038 pediatric patients with COVID-19 were identified. Among these, 308 (30%) had asymptomatic COVID-19. The overall outcome was good, and no patients died. A significant rate of patients aged <24 months and ≥13 years were found in the symptomatic group.

Factors Associated With Corticosteroid Treatment for Pediatric Acute Respiratory Tract Infections

Systemic corticosteroids are not recommended to treat children with acute respiratory tract infections (ARTIs). Using data from a national commercial health care company, we found that corticosteroid treatment occurred in 3.2% of ARTI encounters. The adjusted odds of corticosteroid treatment were highest for bronchitis/bronchiolitis, in emergency departments, and in the South.

#38: Bacteremia Analysis of Three Hospitals in Hispaniola Island

Background In October 2018, the Hispaniola Project was initiated to build local expertise in infection care and prevention at three pediatric oncology units (POUs) in Haiti and the Dominican Republic. Surveillance of healthcare-associated infections (HAI) was a central aim. Severe and prolonged neutropenia is a frequent risk factor for infections in oncology patients. Among HAIs, bacteremia is one of the most serious; bacteremia requires timely isolation and identification of the offending microorganism and the antimicrobial susceptibility. These diagnostic interventions allow informed therapeutic and prophylactic measures. Here, we report our experience in bacteremia in these 3 POUs. Methods We conducted prospective infection surveillance of all patients admitted to three POUs in Hispaniola Island. Blood culture methods followed standard national procedures. We used the 2018 US Centers for Disease Control National Healthcare Safety Network case definitions for primary laboratory-confirmed bloodstream infections (LCBI), and we categorized infections as healthcare-associated or present on admission (POA). We reviewed data collected from January 2019 to December 2020 and used descriptive statistics to report our results. Results Our review identified 66 LCBIs with an overall rate of 3.52 infections per 1000 patient-days. Of these, 40 (61%) were healthcare-associated, and 26 were POA. The majority (41, 62%) of patients were undergoing chemotherapy at the time of the infection, with induction being the most common phase (23). The most common oncologic diagnosis was acute lymphoblastic leukemia (43, 65%), followed by solid tumor (12, 18%). Fifty-three (80%) of the infections met the LCBI-1 criteria, with the other 13 categorized as LBCI-2. Of the 53 LCBI-1, 7 (13%) were considered related to mucosal barrier injury (MBI-LCBI 1 definition). The most commonly identified organisms were Klebsiella spp. (13, 19%) and coagulase-negative Staphylococcus (13, 19%). Antibiotic resistance was observed in many of the identified pathogens, with nearly half (25, 44%) of the 57 bacterial isolates having any resistance and a quarter (14, 25%) with resistance to multiple classes, including cephalosporins, fluoroquinolones, and aminoglycosides. Eleven (17%) patients were admitted to the Intensive Care Unit as a result of the LCBI. Thirteen deaths were recorded among the patients with LCBIs, with 6 (46%) associated with the HAI and 7 (54%) related to disease progression. Conclusions Our findings demonstrate that resistant pathogens were frequent among the LCBI isolates. Our preliminary results are guiding clinical management to be vigilant in our care of patients at high risk for bacteremia and poor clinical response by initiating more effective antimicrobials sooner. Importantly, reviewing reasons for antimicrobial resistance and implementing best antimicrobial use practices will protect our fragile antibiotic arsenal. Infection surveillance programs, such as ours, and other initiatives which promote infection prevention and control in POU will increase the quality of care for these vulnerable patients.

#54: Sensitivity and Specificity of Procalcitonin vs C Reactive Protein in Identifying Pediatric Bacterial infections

Background Procalcitonin (PCT) and c-reactive protein (CRP) have been utilized in children to assess risk for serious bacterial infections. However, there have been different cut-offs reported for PCT and CRP, which yield different sensitivity and specificity. This study aims to compare the sensitivity and specificity of PCT and CRP in detecting serious bacterial infections (SBIs), specifically urinary tract infections, bacteremia and meningitis. Methods In this retrospective, single center cohort study from January 2018 to June 2019, we analyzed children with a fever greater than 38C with both PCT and CRP value within 24 hours of admission. Each patient had a blood, urine and/or cerebrospinal fluid culture collected within 48 hours of admission. No antibiotics were administered from the admitting hospital prior to collection of the PCT or CRP. Our gold standard was a positive culture obtained from blood, cerebrospinal fluid, or urine. The statistical analysis included categorical variables as percentages and compared them using the Fisher exact test. The optimal cutoff values for PCT or CRP were based on ROC curve analysis and Youden Index. Sensitivity and specificity analysis were based on literature review cut offs and ROC curves cut offs. Results Among 202 children, we had 45 culture positive patients (11 urinary tract infections, 4 meningitis, and 32 bacteremia). The patients with culture positivity had higher PCT levels (7.9 ng/mL vs 2.5 ng/mL, P=0.0111), CRP levels (110.9 mg/L vs 49.6 mg/L, P<0.0001) and temperature (39.2C vs 39C, P<0.0052). The area under the curve (AUC) comparing culture positivity vs negativity for all culture types was 0.72 (p<0.0001) for PCT and 0.66 (p=0.001) for CRP. In Figure 1, the AUC for culture positive bacteremia was 0.68 (p=0.0011) for PCT and 0.70 (p=0.0003). The AUC for culture positive urinary tract infections (UTI) only was 0.86 (p=0.0001) for PCT and 0.70 (p=0.3607). For the cut-off value for PCT at 0.5 ng/mL, the sensitivity and specificity was 64% (95% confidence interval [CI] 0.5–0.77) and 70% (95% CI 0.62–0.77) respectively in identifying children with bacterial infection. For the cut-off value for CRP at 20 mg/L, the sensitivity and specificity was 67% (95% CI 0.52–0.79) and 52% (95% CI 0.44–0.59) respectively in identifying children with bacterial infection. Conclusion In this study, PCT and CRP are nearly equivalent classifiers for detecting SBIs as a group and bacteremia, but PCT is statistically better for urinary tract infections; however, the clinical utility is unknown.