BackgroundCommunity acquired Staphylococcus aureus bacteremia (SAB) is a frequent cause of hospitalization in children. Persistent bacteremia (more than 7 days) is associated with higher morbidity. The main objective of this study was to identify clinical predictors of persistent SAB.MethodsProspective cohort study. January 2010- December 2016. Inclusion criteria: age>30 days and <16 years, hospitalized in a pediatric referral hospital with community acquired infections, with development of SA in blood cultures. Exclusion criteria: history of recent hospitalization, attendance at a health care center, living in a closed community, or venous catheter. Microbiological, demographic and clinical characteristics were compared in children when SAB lasted > or < 7 days. Bivariate and multivariate analysis was performed. Stata13 was used.Resultsn 250. One hundred and sixteen (64%) were male. Median age was 60 months (IQR 22–131). Methicillin-resistant Staphylococcus aureus(MRSA) was identified in 163 patients (65%). Clindamycin resistance was identified in 21 cases (8%). Median length of SAB was 3 days (IQR 2–4). In twenty-six patients (11%) SAB lasted 7 or more days. In bivariate analysis, pneumonia (OR 4.6, 95% CI 2–10.6, P < 0.001), sepsis at admission (OR 3.8 95% CI 1.6- 8.7, p 0.002), intensive care unit admission (OR 2.9 95% CI 1.3–7, P < 0.01), delayed drainage (OR 4.7, 95% CI 1.4–16, p: 0.01) and MRSA (OR 7.4, 95% CI 1.7–31, p 0.01) were associated with prolonged SAB. No association with age, sex, site of infection, Vancomycin or Clindamycin empiric treatment was found. In multivariate logistic model, MRSA (OR 5.9 95% CI 1.4–25.9 p: 0.02) and sepsis at admission day (OR 2.9, 95% CI 1.3- 2.5, p: 0.01) were predictors of SAB duration more than 7 days.ConclusionIn this study of Community Acquired SAB, MRSA was prevalent. Methicillin-resistance and sepsis at admission day were identified as predictors of SAB persistence (more than 7 days).Disclosures All authors: No reported disclosures.

The experience using anidulafungin for the treatment of invasive fungal infections in pediatrics is limited. In this article, we describe our experience in 55 children. Anidulafungin was administered intravenously at a loading dose of 3 mg/kg once daily, followed by 1.5 mg/kg every 24 hours over a mean period of 14 days (range: 7-22 days). Patients' median age was 114 months old (interquartile range: 32-168 months old). All patients had underlying diseases. Among patients with bone marrow transplant, the difference in white blood cell count, transaminase levels, and renal function at baseline and at the end of anidulafungin administration was not significant. No adverse events were reported and no patient died from an anidulafungin-related cause. Anidulafungin may be considered an alternative for the prophylaxis or treatment of invasive fungal infections in pediatrics but methodologically robust studies are needed to confirm this.

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Endocarditis por Streptococcus pneumoniae en pediatría. Presentación de un caso clínicoStreptococcus pneumoniae endocarditis in a child: a case report ResumenIntroducción: la incidencia de infecciones invasivas por neumococo ha disminuido desde la generalización de la vacuna neumocóccica conjugada, aunque el neumococo continúa siendo un patógeno prevalente en niños. De las infecciones invasivas por neumococo, la EI (endocarditis infecciosa) es una forma de presentación rara con una incidencia de 1 a 7%. Caso clínico: Presentamos el caso de un niño de 4 años previamente sano, con una única dosis de vacuna 10 valente conjugada para neumococo, que consulta con fiebre, la aparición de un nuevo soplo cardíaco e insuficiencia cardíaca. Presentó desarrollo de S. pneumoniae en hemocultivos, sensible a penicilina. En el ecocardiograma transtorácico se observaron vegetaciones en válvula tricuspídea y pulmonar. Recibió 4 semanas de tratamiento antibiótico con diagnóstico de EI por neumococo. Evolucionó con daño valvular secundario que requirió tratamiento quirúrgico. Conclusiones: Debe considerarse la EI como diagnóstico diferencial ante todo niño febril con la aparición de un nuevo soplo cardíaco, y al neumococo agente etiológico en los pacientes febriles con infecciones graves provenientes de la comunidad. Keywords:Endocarditis; Streptococcus pneumoniae, child, bacterial infections Abstract Introduction: the incidence of invasive infections caused by pneumococcus (Streptococcus pneumoniae) has declined since generalized vaccination with pneumococcal conjugated vaccine, but it is still a prevalent pathogen in children. Amongst pneumococcal invasive infections, IE (infectious endocarditis) is rare, with an incidence between 1 and 7%. Case report: We describe the case of a previously healthy 4 year old boy, who had received one dose of 10-valent pneumococcal conjugate vaccine who presents with fever, a new heart murmur and heart failure. Blood cultures were posi-

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