2800. Carbapenem Resistant Enterobacteriaceae bloodstream infections in children from Latin America & Caribbean region: systematic review and meta-analysis

• Published in: Open forum infectious diseases 2023-11, Vol.10 (Supplement_2)
• Main Authors: Ruvinsky, Silvina, Jimena, Carla, Roel, Macarena, Brizuela, Martin, Portillo, Victoria Maria, Naranjo-Zuniga, Gabriela, Ulloa-Gutierrez, Rolando, Ciapponi, Agustin, Comande, Daniel, Bardach, Ariel
• Format: Article
• Language: English
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofad500.2411

Abstract Background Systematic reviews about the burden and use of resource related to Carbapenem Resistant Enterobacteriaceae bloodstream infections (CRE-BI) in children from Latin America and Caribbean (LAC ) is scarce. Methods Objectives To analyze demographic, epidemiological, clinical, use of resource and microbiological data from CRE-BI in LAC Methods A systematic review following Cochrane methods, PRISMA/MOOSE statements was performed (PROSPERO 2022 CRD42022352504). We searched all databases (MEDLINE, Embase, LILACS, SciELO, CENTRAL, CINAHL, Cochrane Library, WHO Database and relevant websites) from 1/1/2012 to 9/30/2022. Independent selection, data extraction, and risk of bias assessment (RoB) were performed with COVIDENCE. Types of study included; observational/surveillance/experimental/quasi-experimental. Population: Inpatients < 19 years old, with CRE-BI. Outcomes: age, underlying conditions, previous (invasive procedures, colonization, antibiotic treatment, PICU). treatment and use of resources. Statistical analysis: proportion meta-analyses applying an arc-sine transformation and RoBTo, We conducted proportion meta-analyses and applied arc-sine. R studio was used Results 25/858 screened studies included for full text assessment with 243 patients were included. The most represented countries were Brazil (30%), Colombia (26%) and Argentina (22%). Median age was 34.5 months (IRQ 14-85). Predominant resistance mechanisms: KPC (96%), NDM (58%), OXA (27%). Pool proportion were: Male 55%. Underlying conditions 100% (immunocompromised host 84%), Previous Colonization with CRE was 42% (CI95% 13-78) and broad spectrum antibiotic used was 88% (CI95% 46-98%), most commonly carbapenems 84% (CI95% 72-91%) Bacteremia secondary to intra-abdominal infection was 80%. Combination antimicrobial treatment was 96% (CI95% 22-100%). Median length of stay 22.5 (IQR 22-30 days). Overall case fatality ratio was 48% (IC95% 27-69%). Conclusion CRE-BI cause morbidity and mortality mainly in pediatric population with underlying disease in LAC region. Considering its high impact in public health, it's mandatory to establish adequate policies and programs to improve antimicrobial stewardship. Disclosures All Authors: No reported disclosures