Risk Factors for Complications in Children with Staphylococcus aureus Bacteremia.

TitleRisk Factors for Complications in Children with Staphylococcus aureus Bacteremia.
Publication TypeJournal Article
Year of Publication2019
AuthorsHamdy RF, Donà D, Jacobs MB, Gerber JS
JournalJ Pediatr
Volume208
Pagination214-220.e2
Date Published2019 05
ISSN1097-6833
KeywordsAnti-Bacterial Agents, Bacteremia, Catheter-Related Infections, Child, Child, Preschool, Cross Infection, Female, Humans, Infant, Male, Methicillin Resistance, Methicillin-Resistant Staphylococcus aureus, Multivariate Analysis, Poisson Distribution, Regression Analysis, Retrospective Studies, Risk Factors, Staphylococcal Infections
Abstract

OBJECTIVES: To determine risk factors for complications in children with Staphylococcus aureus (S aureus) bacteremia, including methicillin resistance.

STUDY DESIGN: Single center, retrospective cohort study of children ≤18 years of age hospitalized with S aureus bacteremia. We compared clinical characteristics and outcomes between those with methicillin-sensitive S aureus (MSSA) and methicillin-resistant S aureus (MRSA) bacteremia. Multivariate regression models identified risk factors associated with developing complications and with longer duration of bacteremia.

RESULTS: We identified 394 episodes of S aureus bacteremia, 279 (70.8%) with MSSA, and 115 (29.2%) with MRSA. Primary site of infection was catheter-related in 34%, musculoskeletal in 30%, skin/soft tissue in 10.2%, pneumonia in 6.4%, and endovascular in 6.6%. Eight children (2.0%) died within 30 days because of S aureus bacteremia, 15 (3.5%) had recurrence within 30 days, and 38 (9.6%) had complications including septic emboli or a metastatic focus of infection. Methicillin resistance was associated with development of a complication (aOR 3.31; 95% CI 1.60-6.85), and catheter-related infections were less likely to be associated with a complication (aOR 0.40; 95% CI 0.15-1.03). In a Poisson regression analysis on duration of bacteremia, methicillin resistance, musculoskeletal infection, endovascular infection, black race, and delayed intervention for source control were significantly associated with longer duration of bacteremia.

CONCLUSIONS: In this cohort of children with S aureus bacteremia, MRSA infections were associated with longer duration of bacteremia and a higher likelihood of complications.

DOI10.1016/j.jpeds.2018.12.002
Alternate JournalJ. Pediatr.
PubMed ID30879729
Grant ListT32 GM075766 / GM / NIGMS NIH HHS / United States