Background Staphylococcus aureus bacteremia poses significant risk for morbidity and mortality. This may be exacerbated in rural populations facing unique health challenges. Methods To investigate factors influencing S. aureus bacteremia outcomes, we conducted a retrospective cohort study of children admitted to St. Louis Children’s Hospital (SLCH) from 2011-2019. Exposures included rurality (defined by the Rural-Urban Continuum Code), Area Deprivation Index, and outside hospital (OSH) admission prior to SLCH admission. The primary outcome was treatment failure, a composite of 90-day all-cause mortality and hospital readmission. Results Of 251 patients, 69 (27%) were from rural areas; 28 (11%) were initially admitted to an OSH. Treatment failure occurred in 39 (16%) patients. Patients from rural areas were more likely to be infected with methicillin-resistant S. aureus (45%) versus urban children (29%, p = 0.02). Children initially admitted to an OSH, versus those presenting directly to SLCH, were more likely to require intensive care unit-level (ICU) care (57% vs. 29%, p = 0.002), have an endovascular source of infection (32% vs. 12%, p = 0.004), have a longer duration of illness before hospital presentation (4.1 vs. 3.0 days, p = 0.04), and have delayed initiation of targeted antibiotic therapy (3.9 vs. 2.6 days, p = 0.01). Multivariable analysis revealed rural residence (adjusted odds ratio [aOR] 2.3, 95% confidence interval [CI] 1.1-5.0), comorbidities (aOR 2.9, 95%CI 1.3-6.2), and ICU admission (aOR 3.9, 95%CI 1.9-8.3) as predictors of treatment failure. Conclusion Children from rural areas face barriers to specialized healthcare. These challenges may contribute to severe illness and worse outcomes among children with S. aureus bacteremia.
Background: Despite clear benefit of improved outcomes in adults, the impact of Infectious Diseases (ID) consultation for Staphylococcus aureus bacteremia in children remains understudied. Methods: To assess the impact of Pediatric ID consultation on management and outcomes, we conducted a cohort study of children with S. aureus bacteremia at St. Louis Children’s Hospital from 2011–2018. We assessed adherence to six established quality-of-care indicators (QCIs). We applied propensity score methodology to examine the impact of ID consultation on risk of treatment failure, a composite of all-cause mortality or hospital readmission within 90 days. Results: Of 306 patients with S. aureus bacteremia, 193 (63%) received ID consultation. ID consultation was associated with increased adherence to all QCIs, including proof-of-cure blood cultures, indicated laboratory studies, echocardiography, source control, targeted antibiotic therapy, and antibiotic duration. Obtaining proof-of-cure blood cultures and all indicated laboratory studies were associated with improved outcomes. In propensity score-weighted analyses, risk of treatment failure was similar among patients who did and did not receive ID consultation. However, the number of events was small and risk estimates were imprecise. Conclusions: For children with S. aureus bacteremia, ID consultation improved adherence to QCIs, some of which were associated with improved clinical outcomes.
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