391 - Reduction of inpatient antibiotic treatment for infants admitted for sepsis evaluation and found to have a viral infection

Poster Number: 391
Publication Number: 391.243

Guliz Erdem, Nationwide Children's Hospital, Columbus, OH, United States; Joshua Watson, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, United States; Cristina Tomatis Souverbielle, Nationwide Children's Hospital, Columbus, OH, United States; Don A. Buckingham, Nationwide Children's Hospital, Columbus, OH, United States; William J. Barson, The Ohio State College of Medicine, Columbus, OH, United States

Background: Infants with a viral infection undergoing sepsis evaluation could receive prolonged antibiotic treatment due to concerns for a co-existing serious bacterial infection (SBI).  

Objective: Our objective was to decrease the duration of antibiotic treatment in infants less than 60 days of age hospitalized for sepsis evaluation who were found to have a viral infection by rapid diagnostic testing.  Our secondary aim was to decrease the length of stay (LOS) in this patient population.

Design/Methods: The study was conducted among infants admitted for fever without a focus or concern for sepsis to Nationwide Children’s Hospital between January 2019 and December 2021. The baseline data were collected for years 2017 and 2018 for patient age, clinical and laboratory findings including all the culture and rapid viral test results.  These included BioFire respiratory viral panel, meningoencephalitis panel, dedicated PCRs for herpes, parecho- and enteroviruses.  SBI was defined as any positive bacterial culture from urine, blood, and cerebrospinal fluid (CSF) cultures.  Localized bacterial infections (LBI) included skin and soft tissue infections including omphalitis. We excluded patients with SBI, LBI, SARS-CoV-2 infection, or symptoms consistent with bronchiolitis. We monitored the readmission rates within 30 days of discharge.

Results: 2255 infants were admitted since January 2017 with median age of 26 days (Range: 1-55 days). 1203 patients were followed since 2019. 119 (10.3%) of the 1160 patients with a viral infection and 152 (13.9%) of the 1095 patients who did not have a virus identified had a positive bacterial sterile site culture.  After exclusions 664 patients were analyzed for virus positive group.  Pre-study group of 392 patients had median antibiotic treatment of 29.7 hours and study group of 272 patients had antibiotic duration of 21.2 hours (P < 0.05).  The median LOS was 42.25 and 41.8 hours respectively. Of 808 patients who tested negative for viruses, 498 were admitted during the study period with median antibiotic duration of 29.7 hours and LOS of 43.7 hours.  No significant difference in readmission rates was observed.Conclusion(s): During the last three years we demonstrated that the antibiotic treatment can be safely and significantly decreased in clinically stable infants with a documented viral infection after 24 hours of negative bacterial cultures.