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Background Pneumococcal conjugate vaccines (PCV) have decreased pneumonia in children. Colombia introduced massive vaccination with PCV10 in 2012. Methods Pneumococcal pneumonia cases from 10 hospitals part of an active surveillance network for invasive pneumococcal disease were included. Two periods were compared, pre-PCV10: 2008-2012 and post-PCV10: 2014-2019. The objective was to compare characteristics and outcomes before and after PCV10. Results 370 cases were included. Serotype 1(15, 11.2%) and 14 (33, 24.6%) were the most frequent in Pre-PCV10, with only 4(3%) 19A and 1(0.7%) serotype 3. Post-PCV10, serotype 1 decreased to 6(3.1%), 14 to 15(7.8%), while 19A increased to 58(30.2%), serotype 3 to 32(16.7%) and 6A to 7(3.6%) (p = < 0.001), (Graph 1). Complicated pneumonia (CN) also increased (13.4% to 31,8%) (p< 0,001). Pre-PVC10, 44% of CN were due to PCV10 serotypes; with no PCV13 serotypes cases. Post-vaccine period, PCV10 explained only 8.2% and PCV13 60.6%(p < 0.001) of CN. Comparing PICU requirement among predominant serotypes on each period; 23.5% of serotypes 14 and 27.2% of serotypes 1 were admitted, while 59.4% of serotypes 3, 56.9 % of 19A and 42.8% of 6A required PICU. The median of hospitalization increased from 8(5.5-15) to 12 (7-22) days (p < 0.001), as well as the frequency of PICU, 32.8% to 51.6 %, (p = 0.001). Penicillin prescription was similar (17.2% -15.7%), with decrease in ampicillin use (28.4% - 3.6%) and increase ampicillin-sulbactam (0.7% to 24%), and ceftriaxone / clindamycin (0.7% to 5.7%) in post-PCV10. The duration of empirical antibiotic treatment was 7(4-11) and increased to 10(6-17) (p = < 0.001). Lethality showed a slight, non-significant increase between periods 7.5% vs. 9.9% (p = 0.57). (Table1) Graph 1. Serotype distribution 2008 - 2019 Year 2012, PCV10 introduced 2 + 1 schedule. Table 1. Outcomes in the Pre-PCV10 and Post-PCV10 Period Conclusion PCV10 significantly decreased vaccine serotypes, with increase in PCV13 serotypes. 19A, 3 and 6A the predominant serotypes had greater severity including PICU admission, CN and more resistance, with an increase in the use of broad-spectrum antibiotics and longer hospitalization. The current data support national and regional evidence on the importance of replacing PCV10 to a higher valence that include 19A, as PCV13, with the aim of reducing the circulation, particularly of this serotype. Disclosures Ivan Felipe Gutiérrez Tobar, n/a, Pfizer and MSD (Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau, Has received support from Pfizer and MSD for participation in congresses and has received conference payments from Pfizer)Pfizer and MSD (Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Cristina Mariño Drews, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Sandra Beltran, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Aura Lucia Leal Castro, MD, Pfizer and MSD (Research Grant or Support, Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Aura Lucia Leal Castro, n/a, Pfizer and MSD (Research Grant or Support, Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Jaime alberto Patiño-Niño, n/a, Pfizer (Research Grant or Support, Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Martha Isabel Alvarez-Olmos, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Rocio Barrero Barreto, n/a, Pfizer and MSD (Other Financial or Material Support, Has received support from Pfizer and MSD for participation in congresses and has received conference payments from Pfizer) Fabio Espinosa, n/a, MSD (Research Grant or Support, Other Financial or Material Support, Has received support from MSD for other research.) Nicolas Ramos, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Vivian Marcela Moreno Mejia, n/a, Pfizer (Research Grant or Support)

Background COVID 19 infection represents a global threat and now a frequent cause of hospitalization in pediatrics. COVID 19, as well as Influenza virus could have a severe course. There are few studies, and no local or regional information comparing severe disease between COVID 19 and Influenza virus in children. Methods Confirmed COVID 19 between March 2020 to October 2021 and influenza infections from Jan-2017 to dec-2019 were included. Asymptomatic or ambulatory COVID 19 infections were excluded. The main objective was to compare clinical, laboratory and outcome characteristic of PICU admitted patients. Results 71 patients were included, 32(45,1%) with COVID 19 and 39 (54,9%) influenza virus. COVID 19 patients were older than influenza patients: 67 (20,5-143) vs. 10 (2- 46) p=0.0002. The majority of influenza patients were younger than two years, with different distributions in COVID 19 patients. Figure 1. Respiratory distress was more frequent in influenza (92,3% vs. 62,5%) p=0.002, but exanthema (28,1% vs 2,6%), shock (68,7% vs. 7,7%) and central nervous system manifestations (40,6% vs. 7,7%) were significantly more common in COVID19 than in Influenza respectively. COVID 19 had lower platelets and lymphocyte counts than inlfuenza. There were no differences in treatment, nor deceased either, but Influenza patients had slightly longer hospital stays 12 (7 – 23) vs. 9.5 (6–15.5) p=0.1592 than COVID 19 (Table 1). Table 1. Comparison of demographic and clinical characteristics of COVID 19 vs. Influenza patients. Conclusion COVID 19 and influenza severe infections can have some differences including age of presentation. Inlfuenza main manifestation requiring UCIP is respiratory distress, while COVID19 can have other presentations including shock and central nervous manifestation. Lower lymphocyte counts as well as lower platelets were significantly more common in COVID 19 patients. Although there are no unique characteristics of each infection, some particularities could guide clinician to the etiology of the infection. Disclosures Ivan Felipe Gutiérrez Tobar, n/a, Pfizer and MSD (Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau, Has received support from Pfizer and MSD for participation in congresses and has received conference payments from Pfizer)Pfizer and MSD (Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Sandra Beltran, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses)

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Background Urinary tract infections (UTI) are common in children with a prevalence of 5% in infants. UTI are the main reason for beginning antibiotics in children’s hospitals and E. coli is approximate 80% of urinary pathogens. Extended-spectrum beta-lactamases (ESBL) producing E. coli are a common concern in daily practice. Carbapenems, especially ertapenem are the choice for the treatment in some hospitals, but aminoglycosides or trimethoprim and sulfamethoxazole are options for carbapenem saver. The aim of this study was comparing the clinical outputs in ESBL producing E. coli ITU in children treated with ertapenem or amikacin. Methods We designed a quasi-experimental study. In 2018 the antimicrobial stewardship program begins the use of amikacin for non-septic UTI for ESBL producing E. coli. Before this recommendation the use of ertapenem was common. We use WHONET 5.6 to identify ESBL producing E. coli UTI between 2016 and 2020. We analyzed the information using R 4.0.3. Results We analyzed 162 clinical records. 89 in ertapenem group, 45 in amikacin group, 23 in other treatments (TMP-SMX, meropenem) and 5 patients that received empirical treatment (Cefazolin) with clinical improvement and ambulatory management. The initial clinical and paraclinical variables was similar between two groups, only meropenem was more frequent in amikacin group as empiric treatment (table 1). Amikacin group received for media 7.4 days of antibiotic therapy (IQR 7-7.5) and ertapenem 8.2 days (IQR 7-10) (p value 0.049). The mortality, PICU requirement, mechanical ventilation and inotropic requirement was similar an both groups (Table 2). In amikacin group the median length of stay was 7.2 days (IQR 4-9) and in ertapenem group was 9 days (IQR 6-10). No significant adverse effects were documented in any group. Table 1. Patient’s characteristics in both groups. Table 2. Patient’s Clinical outcomes in both groups Conclusion The use of amikacin in ESBL producing E. coli UTI in children have similar clinical outputs that ertapenem. The use of amikacin could decrease de hospitalization time. Disclosures Ivan Felipe Gutiérrez Tobar, n/a, Pfizer and MSD (Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau, Has received support from Pfizer and MSD for participation in congresses and has received conference payments from Pfizer)Pfizer and MSD (Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses)