Epidemiology and hospital readmission associated with complications ofStaphylococcus aureusbacteremia in pediatrics over a 25-year period

Abstract

We sought to comprehensively assess the prevalence and outcomes of complications associated with Staphylococcus aureus bacteremia (SAB) in children. Secondarily, prevalence of methicillin resistance and outcomes of complications from methicillin-resistant S. aureus (MRSA) vs. methicillin-susceptible S. aureus SAB were assessed. This is a single-center cross-sectional study of 376 patients ⩽18 years old with SAB in 1990-2014. Overall, 197 (52%) patients experienced complications, the most common being osteomyelitis (33%), skin and soft tissue infection (31%), and pneumonia (25%). Patients with complications were older (median 3 vs. 0·7 years, P = 0·05) and more had community-associated SAB (66% vs. 34%, P = 0·001). Fewer patients with complications had a SAB-related emergency department or hospital readmission (10% vs. 19%, P = 0·014). Prevalence of methicillin resistance increased from 1990-1999 to 2000-2009, but decreased in 2010-2014. Complicated MRSA bacteremia resulted in more intensive care unit admissions (66% vs. 47%, P = 0·03) and led to increased likelihood of having ⩾2 foci (58% vs. 26%, P < 0·001). From multivariate analysis, community-associated SAB increased risk and concurrent infections decreased risk of complications (odds ratio (OR) 1·82 (1·1-3·02), P = 0·021) and (OR 0·58 (0·34-0·97), P = 0·038), respectively. In conclusion, children with SAB should be carefully evaluated for complications. Methicillin resistance remains associated with poor outcomes but have decreased in overall prevalence.

Whole-genome sequencing to explore nosocomial transmission and virulence in neonatal methicillin-susceptible Staphylococcus aureus bacteremia

“…A significant risk factor for S. aureus bacteremia in VLBW infants is the presence of intravascular catheters, which are frequently required [6][7][8]. In addition, S. aureus bacteremia can result in severe complications such as endocarditis and osteomyelitis [5,9,10]. All-cause mortality among neonates suffering from S. aureus bacteremia varies between 10 and 20% [7,11].…”

Epidemiology of Staphylococcus aureus infections in patients admitted to freestanding pediatric hospitals, 2009–2016

“…Staphylococcus aureus (S. aureus) causes a substantial number of pediatric infections each year in the United States, with potential for severe complications including death. [1][2][3][4] Although the emergence of methicillin-resistant S. aureus (MRSA) led to a rapid increase in the number of S. aureus infections in children, 5 recent data suggest that S. aureus infections are declining in adults, driven primarily by decreases in MRSA. 6,7 Similar findings have been reported in pediatric populations, but these studies were limited to single centers and unique populations, such as military members or infants.…”

“…6,7 Similar findings have been reported in pediatric populations, but these studies were limited to single centers and unique populations, such as military members or infants. 4,5,[8][9][10] A nationally representative and contemporary characterization of epidemiologic trends in S. aureus infections has not been conducted. The objective of this study was to describe recent trends in pediatric S. aureus hospitalizations and associated antibiotic prescribing patterns.…”

Prognostic factors of severity of invasive community acquired Staphylococcus aureus infections in children

“…This is different from other series done both in the USA and Europe. 12,15,16 Forty percent of S. aureus causing invasive infections in this series was methicillin-resistant. These findings demonstrate that the growing epidemics of methicillin-resistant S. aureus, which has been reported in different countries in both the Northern and Southern hemispheres, has not escaped our country, thus anticipating the increase in resistance to be seen in the next years.…”

“…The incidence of metastatic sources in S. aureus bacteremias ranges from 15 % to 68 % in different studies and accounts for a marker of severity. 16,22,23 Among the patients admitted to the ICU, MRSA was isolated in 57 %, which was a significantly higher proportion than among those who did not require admission to the ICU (p < 0.01). MRSA infections were more severe (higher frequency of pneumonia, bacteremia, and multifocal disease) ( Table 2), which may explain the higher frequency of admission to the ICU.…”