Pediatric Staphylococcus aureus Bacteremia: Clinical Spectrum and Predictors of Poor Outcome

Abstract

Background Staphylococcus aureus is a common cause of bacteremia, yet the epidemiology, and predictors of poor outcome remain inadequately defined in childhood. Methods ISAIAH is a prospective, cross-sectional study of S. aureus bacteremia (SAB), in children hospitalized in Australia and New Zealand, over 24-months (2017–2018). Results Overall, 552 SABs were identified, (incidence 4.4/100,000/yr [95% confidence interval (CI) 2.2-8.8]), with methicillin-susceptible (84%), community onset (78%) infection predominating. Indigenous children (8.1/100,000/yr [CI 4.8-14.4]), those from lower-socioeconomic areas (5.5/100,000/yr [CI 2.8-10.2]) and neonates (6.6/100,000/yr (CI 3.4-11.7) were over-represented. Although 90-day mortality was infrequent, one-third experienced the composite of: length of stay >30 days (26%), ICU admission (20%), relapse (4%), or death (3%). Predictors of mortality included prematurity (aOR 16.8 [CI 1.6-296.9]), multifocal infection (aOR 22.6 [CI 1.4-498.5]), necrotizing pneumonia (aOR 38.9 [CI 1.7 – 1754.6]), multiorgan dysfunction (aOR 26.5 [CI 4.1-268.8]) and empiric-vancomycin (aOR 15.7 [CI 1.6-434.4]); whilst Infectious Diseases (ID) consultation (aOR 0.07 [CI 0.004-0.9]) was protective. Neither MRSA nor vancomycin trough-targets impacted survival; however, empiric-vancomycin was associated with significant nephrotoxicity (OR 3.1 [CI 1.3-8.1]). Conclusions High SAB incidence was demonstrated, with at-risk populations identified for future prioritized care. For the first time in a pediatric setting, necrotizing pneumonia and multifocal infection were predictors of mortality, whilst ID consultation was protective. The need to re-evaluate pediatric vancomycin trough-targets and limit unnecessary empiric-vancomycin exposure, to reduce poor outcomes and nephrotoxicity is highlighted. One in three children experienced considerable SAB morbidity, therefore pediatric inclusion in future SAB comparator trials is paramount to improve outcomes.

Staphylococcus aureus Community-acquired Pneumonia in Children After 13-Valent Pneumococcal Vaccination (2008–2018): Epidemiology, Clinical Characteristics and Outcomes

“…21,22,27 A recent large, prospective study evaluating 552 children with S. aureus bacteremia found that whereas developing necrotizing pneumonia increased mortality, the isolation of MRSA did not. 34 Several factors, such as previous MRSA infection or colonization, recurrent skin infections and long-term hemodialysis have been associated with MRSA CAP in adults. 30,38 We found that children with MRSA were more frequently male and more frequently had relevant chronic clinical conditions than those with MSSA.…”

The burden of bacterial skin infection, scabies and atopic dermatitis among urban-living Indigenous children in high-income countries: a protocol for a systematic review

“…sepsis, osteomyelitis) and postinfectious complications (i.e. acute rheumatic fever, acute post-streptococcal glomerulonephritis) [2][3][4][5].…”

Increasing Pediatric Infectious Diseases Consultation Rates for Staphylococcus aureus Bacteremia

“… 26 A recent prospective cross-sectional study by Campbell et al found that 4% of children with SAB had a relapse within 3 months. 31 In that study, IDC was protective against mortality related to SAB (adjusted odds ratio 0.07 with 95% confidence interval [95%CI] 0.004–0.9). 31 In another recent study, Duguid et al retrospectively compared the outcome of pediatric SAB cases with and without IDC.…”

“… 31 In that study, IDC was protective against mortality related to SAB (adjusted odds ratio 0.07 with 95% confidence interval [95%CI] 0.004–0.9). 31 In another recent study, Duguid et al retrospectively compared the outcome of pediatric SAB cases with and without IDC. They found that IDC was independently associated with cure, defined as the absence of death or relapse at 30 days (odds ratio 31.5.…”