Upper respiratory illnesses due to viruses are the most common reason for pediatric emergency department (ED) visits in the United States. We explored the clinical characteristics, hospitalization risk, and symptom duration of children in an ED setting by respiratory pathogen including coinfections. A retrospective analysis was conducted from a randomized controlled trial evaluating a rapid molecular pathogen panel among 931 children 1 month to 18 years of age with acute respiratory illness.We assessed hospitalization risk by pathogen using multivariable Poisson regression with robust variance. Symptom duration was assessed using multivariable Cox proportional hazards models. Among 931 children, 702 (75%) were aged 0-5 years and 797 (85%) tested positive for a respiratory pathogen. Children with respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and human rhinovirus/ enterovirus (HRV/EV) had higher hospitalization risk compared with influenza

Background Antimicrobial resistance (AMR) is an increasing global threat to public health, particularly in Latin America. Most published data are based on adults with limited pediatric reports regarding resistance trends. Our study evaluated AMR rates in a large tertiary pediatric hospital in Guatemala City and the association with clinical outcomes. Methods We analyzed AMR rates for six bacterial species (Acinetobacter baumannii, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus) identified from blood cultures from the WHONET database between 2005-2019. Resistance was determined using CLSI cut-offs on the VITEK and Sensititre systems. Student’s t tests and simple linear regression models were performed. A retrospective review was performed on 99 pediatric patient charts with positive blood cultures (June 2018-May 2019) to assess clinical outcomes. Results Klebsiella and Acinetobacter were the most prevalent organisms throughout the 15 years of surveillance, with 2019 sensitivities demonstrating carbapenem-resistance in 99 (57%) and 57 (91%) of isolates, respectively. Increased resistance rates were noted for all Gram-negative organisms evaluated, with particular clinical and statistical significance noted for K. pneumoniae with imipenem (4.3% average resistance increase per year (PARPY), p-value < 0.0001), ciprofloxacin (4.5 PARPY, < 0.0001), and piperacillin-tazobactam (3.4 PARPY, < 0.0001), as well as A. baumannii with imipenem (2.9 PARPY, p-value < 0.0001), cefepime (1.7 PARPY, < 0.0001), and ciprofloxacin (2.5 PARPY, 0.0002). In contrast, resistance rates decreased for S. aureus with oxacillin (-2.7 PARPY, 0.0015). A mortality rate of 20% among our 99-patient cohort was detected. Of the 37% who received optimal therapy, the median time to optimal therapy was 90 hours. Acinetobacter baumannii resistance to imipenem, 2005-2019 Klebsiella pneumoniae resistance to imipenem, 2005-2019 Staphylococcus aureus resistance to oxacillin, 2005-2019 Conclusion Significant rises in AMR among pediatric patients in a large tertiary hospital in Guatemala City have occurred over 15 years. This likely contributed to delays in optimal antimicrobial therapy, increased exposure to broad spectrum antibiotics, and potentially increased mortality. Improved antimicrobial stewardship, infection prevention, and rapid diagnostic testing are needed in order to combat this growing problem. Disclosures Kelly E. Graff, MD, BioFire Diagnostics, LLC (Grant/Research Support) Samuel Dominguez, MD, PhD, BioFire (Consultant, Research Grant or Support)

Antimicrobial resistance (AMR) is increasing worldwide. We analyzed AMR rates for bacterial species identified from pediatric blood cultures between 2005 and 2019 at a single institution in Guatemala. We found significantly increased rates in Gram-negative resistance, with a high prevalence of carbapenem-resistant Acinetobacter and Klebsiella harboring the New Delhi metallo-beta-lactamase gene.

The Influenza Hospitalization Surveillance Network (IHSN or FluSurv-NET) was evaluated using the Centers for Disease Control and Prevention's (CDC) guidelines for evaluating a public health surveillance system. The IHSN was evaluated for usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, positive predictive value, representativeness, timeliness, and stability. The IHSN was found to utilize a broad range of sources for influenza surveillance which can be openly accessed via the CDC's "FluView" online application. The IHSN is highly adaptable with its capacity to accommodate additional data sources when needed. The overinclusiveness of different laboratory diagnostic methodologies was found to be detrimental to the overall data quality of the IHSN in the form of variable sensitivity and positive predictive value measures amongst the CDC's acceptable testing methods. Overall, the IHSN is a very robust system that allows for timely access to influenza data by public health officials. However, the inclusivity of the IHSN causes it to fall short when considering the importance of consistency in data collection practices. The IHSN fails to take into account several factors that could either artificially increase, or decrease case counts. We recommend the IHSN integrate a more streamlined and reliable data collection process and standardize its expectations with all of its reporting sites.