Background: There has been dramatic reduction in Haemophilus influenzae serotype b (Hib) since introduction of Hib vaccines, but children still experience serious invasive Haemophilus influenzae (Hi) disease caused by various serotype and non-typeable bacteria.The object of this study was to describe the serotype distribution and clinical spectrum of Hi bacteremia in children admitted to Canadian hospitals.Methods: All children with Hi bacteremia admitted 2013 through 2017 to 10 centres across Canada were included.Demographic, clinical, treatment and outcome data were collected.Results: Haemophilus influenzae bacteremia occurred in 118 children of median age 12 months (inter-quartile range: 7-48 months).Forty-three (36%) isolates were non-typeable (NTHi) and 8 were not typed.Of the 67 typeable (THi), Hia (H.influenzae serotype a) (n=36, 54%), Hif (serotype f) (n=19, 26%) and Hib (serotype b) (n=9, 13%) dominated.The THi was more likely than NTHi bacteremia to present as meningitis (p<0.001),particularly serotype a (p=0.04) and less likely to present as pneumonia (p<0.001).Complicated disease (defined as intensive care unit admission, need for surgery, long-term sequelae or death) occurred in 31 (26%) cases and were more likely to have meningitis (p<0.001)than were those with uncomplicated disease. Conclusion:In the era of efficacious conjugate Hib vaccines, NTHi, Hia and Hif have emerged as the leading causes of invasive Hi in Canadian children, with Hia being most likely to result in meningitis and complicated disease.A vaccine for all NTHi and THi would be ideal, but knowledge of the current disease burden from circulating strains will inform prioritization of vaccine targets.

Abstract Background Antimicrobial resistance is a public health threat, invasive infection from multi-drug resistant gram-negative (MDRGN) pathogens is associated with significant morbidity and mortality. The incidence of MDRGN bacteremia in Canada is rising, and pediatric data is limited. Methods This retrospective chart review of paediatric patients with gram negative bacteremia in a multicenter PICNIC database (n=7 centers) from 2013 to 2017. MDRGN was defined as enterobacteriaceae that were resistant to third generation cephalosporins (including ESBL, CPE). Ethics approval was obtained at all sites, and data was entered into a secure REDCAP database, descriptive statistics are described herein. Results Of the 676 bacteremia patients in the database, 214 (31.7%) were gram negative pathogens. E. coli was the most frequent pathogen (59.8%, of which 22 of 128 were MDR), followed by Klebsiella (31.8%, of which 9 of 68 were MDR). Of the 31 MDRGNs, 19 were ESBL, 1 was a CPE, and 11 were nonspecific mechanisms of resistance. There were no multidrug resistant Pseudomonas, Stenotrophomonas, or Acinetobacter. The majority of patient were less than 3 months of age (59.3%) and were male (58.8%). The majority had an underlying comorbid condition; hematoncologic diagnosis accounting for 14.5%. Length of stay varied from 1 to 742 days (mean 72, standard deviation 88). 11% required admission to ICU, 10% required removal of a intravascular catheter, 7% required a change in ventilation status, 2% requiring procedural source control, and there was an 8% mortality rate. Treatment duration greater than 14 days occurred in 123 patients (61% of patients). Conclusion This preliminary analysis of a multicenter review of pediatric gram negative bacteremias demonstrates a higher risk in neonates with comorbid conditions. A surprisingly prolonged treatment duration of greater than 14 days occurred in the majority of patients. Further analysis to assess factors associated with prolonged treatment durations, MDR infection, and complications is required. Gram negative bacteremia remains a significant cause of morbidity and mortality in pediatric patients. Disclosures All Authors: No reported disclosures

Contexte : La vaccination a entraîné une diminution de l'incidence de la méningococcie invasive au Canada, mais cette infection est toujours à l'origine d'un taux de morbidité et d'une mortalité important.Objectifs : L'objectif de cette étude était de déterminer la charge de morbidité et la gestion de la méningococcie invasive dans les hôpitaux pédiatriques.Méthodes : Des données ont été recueillies sur tous les cas de méningococcie invasive dans huit hôpitaux pédiatriques entre 2013 et 2017.Résultats : Il y a eu 17 cas de méningococcie invasive.Trois des huit hôpitaux n'avaient aucun cas.Un peu plus de la moitié des cas étaient du sérogroupe B (n = 9); un quart (n = 4) étaient du sérogroupe W; moins d'un quart (n = 3) étaient du sérogroupe Y; et un était inconnu.Deux enfants infectés n'ont commencé à prendre des antibiotiques qu'au premier et au cinquième jour après la première hémoculture, mais leur rétablissement s'est fait sans incident.Six cas ont nécessité une admission en unité de soins intensifs; deux sont morts.Six cas de méningite probable ou avérée.La thrombocytopénie a été documentée dans sept cas.Tous les cas présentaient des taux élevés de protéine C réactive.Sept enfants ont reçu plus de sept jours d'antibiotiques; sur ces sept enfants, seuls deux présentaient des complications justifiant un traitement prolongé (empyème sous-dural et genou septique).Un cathéter veineux central a été placé dans six cas. Conclusion :La méningococcie invasive est désormais rare chez les enfants canadiens, mais environ un tiers des cas de notre étude ont nécessité un traitement dans l'unité de soins intensifs et deux sont morts.Les cliniciens ne semblent pas toujours être conscients qu'un cours de cinq à sept jours est suffisant pour les cas simples de bactériémie ou de méningite.

BackgroundImmunizations have led to a decrease in the incidence of invasive meningococcal disease (IMD) in Canada, but this infection still leads to significant morbidity and mortality.ObjectivesThe purpose of this study was to determine the burden of illness and management of IMD in paediatric hospitals.MethodsData were collected on all cases of IMD in eight paediatric hospitals from 2013 to 2017.ResultsThere were 17 cases of IMD. Three of eight hospitals had no cases. Just over half of the cases were serogroup B (n=9); a quarter (n=4) were serogroup W; less than a quarter (n=3) were serogroup Y; and one was unknown. Two infected children were not started on antibiotics until day one and day five after the initial blood culture was collected, but had uneventful recoveries. Six cases required admission to intensive care units; two died. Six cases had probable or proven meningitis. Thrombocytopenia was documented in seven cases. All cases had elevated C-reactive protein levels. Seven children received more than seven days of antibiotics; of these seven, only two had complications that justified prolonged therapy (subdural empyema and septic knee). Six cases had a central line placed.ConclusionIMD is now rare in Canadian children, but about one-third of the cases in our study required treatment in the intensive care unit and two died. Clinicians appear to not always be aware that a five to seven-day course is adequate for uncomplicated cases of bacteremia or meningitis.

Abstract Background Our objective was to describe the serotype distribution and clinical spectrum of invasive Haemophilus influenza (Hi) disease in children admitted to participating centers within the Paediatric Investigator’s Collaborative Network on Infections in Canada (PICNIC). Methods All cases of Hi bacteremia were identified from the PICNIC Database of Gram-negative bacteremia (2013–2017). Disease was defined as complicated if the following occurred: (a) >2 sites were affected, (b) surgical intervention was required, (c) organ failure, (d) ICU admission, (e) seizures, (f) sensory or motor deficits, (g) treatment-related complications, or (h) death. Results There were 98 cases of Hi bacteremia. Male to female ratio was 64:34 and median age was 12 (IQR: 7–48; range 0–216) months. Hi serotypes included: a (N = 31; 32%), b (N = 9; 9%), f (N = 15; 13%), c (N = 1;1%), e (N = 1; 1%), nontypeable (N = 34; 35%) and unknown (N = 7; 7%). Clinical foci included: bacteremia without a focus (N = 19; 19%), meningitis (N = 29; 30%), cellulitis (N = 8; 8%), septic arthritis (N = 6; 6%), pneumonia (n = 33; 34%), epiglottitis (N = 1; 1%), and endovascular infection (n = 3; 3%). Complicated disease occurred in 29 (30%) cases; there was one (1%) death. Where serotyping was available, complication rates were: 42%, 22%, 100%, 0%, 33%, and 21% for Hia, Hib, Hic, Hie, Hif and nontypeable Hi, respectively. Factors associated with complicated disease were: age <5 years (P = 0.009), bacteremia without a focus (P = 0.006) and a CNS focus (P < 0.001). Hia was the leading serotype in meningitis (55%; P = 0.022). Nontypeable Hi was most frequent in pneumonia cases (56%; P = 0.003) and never caused cellulitis (0% vs. 14%; P = 0.023). Neonatal disease (N = 5) was predominantly caused by nontypeable Hi (80%; P = 0.040). Of note, 26 (27%) of our Hi isolates were ampicillin resistant. Conclusion In the era of efficacious conjugate Hib vaccines, serotype has emerged as the leading cause of typeable Hi disease in Canada and is highly associated with meningitis, especially in young children. Strategies for preventing Hi disease need to target this emerging serotype and efforts should be focused toward developing an effective vaccine for serotype a disease. Disclosures All Authors: No reported Disclosures.