Pediatric <i>Staphylococcus aureus</i> bacteremia: clinical spectrum and predictors of poor outcome

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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.

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Author and article information

Journal

Title: Clinical Infectious Diseases

Publisher: Oxford University Press (OUP)

ISSN (Print): 1058-4838

ISSN (Electronic): 1537-6591

Publication date Created: June 05 2021

Publication date (Electronic): June 05 2021

Affiliations

[1 ]Department of Infectious Diseases, Perth Children’s Hospital, Perth, Australia

[2 ]Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia

[3 ]School of Medicine, University of Western Australia, Perth, Australia

[4 ]Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman

[5 ]Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Randwick, Sydney, Australia

[6 ]The Children's Department of Infectious Diseases and Microbiology, the Children’s Hospital at Westmead, NSW, Australia

[7 ]Department of General Medicine, Infectious Diseases Unit, Royal Children’s Hospital, Melbourne, Australia

[8 ]Infection and Immunity Group, Murdoch Children’s Research Institute, Melbourne, Australia

[9 ]Department of Paediatrics, Wagga Wagga Base Hospital, New South Wales, Australia

[10 ]Department of Paediatrics; Child and Youth Health, The University of Auckland

[11 ]The National Immunisation Advisory Centre, The University of Auckland

[12 ]Department of Infectious Diseases, Starship Children’s Hospital, Auckland, New Zealand

[13 ]Department of Paediatrics, Kidz First Hospital, Auckland, New Zealand

[14 ]Department of Infectious Disease, Barwon Health, Geelong, Australia

[15 ]School of Medicine, Deakin University, Geelong, Australia

[16 ]Sydney Medical School and Marie Bashir Institute, University of Sydney, NSW, Australia

[17 ]Department of Infectious Diseases and Microbiology, the Children’s Hospital at Westmead, Sydney, Australia

[18 ]Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia

[19 ]Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia

[20 ]Infectious Diseases Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia

[21 ]Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, Western Australia

[22 ]Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia

[23 ]University of Western Australia. School of Medicine, Perth, Western, Australia

[24 ]Department of General Paediatrics, Monash Children’s Hospital, Monash Health, Victoria, Australia

[25 ]Department of Paediatrics, Monash University, Clayton, Australia

[26 ]Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Royal Perth Hospital and Fiona Stanley Hospital, Western Australia

[27 ]Antimicrobial Resistance and Infectious Diseases Research (AMRID) Laboratory, Murdoch University, Perth, Western Australia

[28 ]The Australian Group on Antimicrobial Resistance (AGAR)

[29 ]Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia

[30 ]Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia

[31 ]Doherty Institute of Infection and Immunity, The Royal Melbourne Hospital, The University of Melbourne

[32 ]College of Science, Health, Engineering and Education, Murdoch University, Murdoch

[33 ]School of Biomedical Sciences, University of Western Australia, Nedlands

[34 ]Queensland Children’s Hospital, Brisbane, Australia

[35 ]Faculty of Medicine, University of Queensland, Australia

[36 ]Infection & Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia

[37 ]Department of Pediatrics, Monash University, Clayton, Australia

[38 ]Infectious Diseases Department, Women's and Children's Hospital, Adelaide

[39 ]School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia

[40 ]National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia

[41 ]Department of Infectious Diseases, Perth Children’s Hospital, Nedlands

[42 ]Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia

[43 ]Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia

[44 ]Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute

[45 ]School of Medicine, University of Western Australia, Subiaco

[46 ]Menzies School of Health Research, Charles Darwin Hospital, Darwin, NT

Article

DOI: 10.1093/cid/ciab510

PubMed ID: 34089594

SO-VID: bc4146cb-e2a0-4b6a-9852-5ab59cc0bfa0

License:

https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model

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