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Devautour C, Poey N, Lagier J, Launay E, Cerdac A, Vergnaud N, Berneau P, Parize P, Ferroni A, Tzaroukian L, Pinhas Y, Pinquier D, Lorrot M, Dubos F, Caseris M, Ouziel A, Chalumeau M, Cohen JF, Toubiana J. Salvage strategy for long-term central venous catheter-associated Staphylococcus aureus infections in children: a multi-centre retrospective study in France. J Hosp Infect 2024; 150:125-133. [PMID: 38880286 DOI: 10.1016/j.jhin.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVES Catheter removal is recommended in adults with Staphylococcus aureus central-line-associated bloodstream infection (CLABSI) but is controversial in children with long-term central venous catheters (LTCVC). We evaluated the occurrence of catheter salvage strategy (CSS) in children with S. aureus LTCVC-associated CLABSI and assessed determinants of CSS failure. METHODS We retrospectively included children (<18 years) with an LTCVC and hospitalized with S. aureus CLABSI in eight French tertiary-care hospitals (2010-2018). CSS was defined as an LTCVC left in place ≥72 h after initiating empiric antibiotic treatment for suspected bacteraemia. Characteristics of patients were reviewed, and multi-variable logistic regression was performed to identify factors associated with CSS failure (i.e., persistence, recurrence or complications of bacteraemia). RESULTS We included 273 episodes of S. aureus LTCVC-associated CLABSI. CSS was chosen in 194 out of 273 (71%) cases and failed in 74 of them (38%). The main type of CSS failure was the persistence of bacteraemia (39 of 74 cases, 53%). Factors independently associated with CSS failure were: history of catheter infection (adjusted odds ratio (aOR) 3.18, 95% confidence interval (CI) 1.38-7.36), CLABSI occurring on an implantable venous access device (aOR 7.61, 95% CI 1.98-29.20) when compared with tunnelled-cuffed CVC, polymicrobial CLABSI (aOR 3.45, 95% CI 1.25-9.50), and severe sepsis at the initial stage of infection (aOR 4.46, 95% CI 1.18-16.82). CONCLUSIONS CSS was frequently chosen in children with S. aureus LTCVC-associated CLABSI, and failure occurred in one-third of cases. The identified risk factors may help clinicians identify children at risk for CSS failure.
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Affiliation(s)
- C Devautour
- Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - N Poey
- Department of General Pediatrics and Infectious Diseases, Robert Debré University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - J Lagier
- Department of Pediatrics, Hospices Civils de Lyon, Lyon, France
| | - E Launay
- Department of Pediatrics, CHU Nantes, Nantes, France
| | - A Cerdac
- Pediatric Emergency Medicine & Infectious Diseases, CHU Lille, Lille, France
| | - N Vergnaud
- Department of General Pediatrics, Trousseau University Hospital, AP-HP, Pierre et Marie Curie University, Sorbonne Paris, Paris, France
| | - P Berneau
- Department of Pediatrics, Centre Hospitalier de Rennes, Rennes, France
| | - P Parize
- Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - A Ferroni
- Department of Clinical Microbiology, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - L Tzaroukian
- Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen, France
| | - Y Pinhas
- Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - D Pinquier
- Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen, France
| | - M Lorrot
- Department of General Pediatrics, Trousseau University Hospital, AP-HP, Pierre et Marie Curie University, Sorbonne Paris, Paris, France
| | - F Dubos
- Pediatric Emergency Medicine & Infectious Diseases, CHU Lille, Lille, France
| | - M Caseris
- Department of General Pediatrics and Infectious Diseases, Robert Debré University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - A Ouziel
- Department of Pediatrics, Hospices Civils de Lyon, Lyon, France
| | - M Chalumeau
- Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - J F Cohen
- Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - J Toubiana
- Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France.
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Al-Iede M, Ayyad DM, Etoom RA, Aldameiry RH, Toubasi AA. The prevalence and risk factors of methicillin-resistant Staphylococcus aureus among pediatric populations: a systematic review and meta-analysis. Eur J Pediatr 2024:10.1007/s00431-024-05672-7. [PMID: 38970703 DOI: 10.1007/s00431-024-05672-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/22/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
There is scarcity in the data about MRSA prevalence and risk factors among the pediatric population. This research explores the global prevalence and risk factors of MRSA among the pediatric population. PubMed, Scopus, Web of Sciences, and the Cochrane Central Register of Controlled Trials were systematically searched. Our primary goal was to assess the prevalence of MRSA colonization and its related risk factors in the general pediatric population. A total of 124 studies encompassing 44 million participants were included in this meta-analysis, and the overall pooled estimated global prevalence of MRSA colonization in pediatric was 5% [95% CI 4-5%]. Female sex (OR = 4.17; 95% CI, 3.31-5.27), recent surgery (OR = 3.79; 95% CI, 2.20-6.52), recent hospitalization (OR = 2.63; 95% CI, 1.78-3.86), and antibiotic use (OR = 2.42; 95% CI, 1.58-3.72) were significantly associated with higher odds of MRSA colonization. CONCLUSION Future research should build on these findings by emphasizing ongoing efforts to combat MRSA in pediatric settings and implementing targeted interventions. WHAT IS KNOWN • Methicillin-resistant Staphylococcus aureus (MRSA) is considered a threat to public health. It is noteworthy to mention that the prevalence of MRSA strains has not been adequately quantified in many countries, especially in the pediatric population. The pediatric population is a pivotal source of MRSA and may play a central role in its distribution in both community and healthcare settings. A notable study underscores the gravity of the situation, estimating a tenfold increase in the incidence of MRSA infection among children in the USA between 1999 and 2008. WHAT IS NEW • Here we present the first global systematic review and meta-analysis to investigate the prevalence and risk factors of MRSA among the pediatric population. A total of 124 studies encompassing 44 million participants were included in this analysis. The overall pooled estimated global prevalence of MRSA colonization in the pediatric population was 5% [95% CI 4-5%]. The prevalence was the highest in Asia and lowest in Europe. Female sex, recent surgery, recent hospitalization, and antibiotic use were significantly associated with higher odds of MRSA colonization.
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Affiliation(s)
- Montaha Al-Iede
- School of Medicine, The University of Jordan, Queen Rania Street, Amman, 11942, Jordan.
- Department of Pediatrics, Jordan University Hospital, Amman, Jordan.
- Department of Pediatrics, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Dania M Ayyad
- School of Medicine, The University of Jordan, Queen Rania Street, Amman, 11942, Jordan
| | - Rasha A Etoom
- School of Medicine, The University of Jordan, Queen Rania Street, Amman, 11942, Jordan
| | - Rawaby H Aldameiry
- School of Medicine, The University of Jordan, Queen Rania Street, Amman, 11942, Jordan
| | - Ahmad A Toubasi
- School of Medicine, The University of Jordan, Queen Rania Street, Amman, 11942, Jordan
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Thornley EM, Alexander R, Popelka J, Montgomery CP. Risk Factors for Persistent Staphylococcus aureus Bacteremia in Children. Pediatr Infect Dis J 2024:00006454-990000000-00910. [PMID: 38905222 DOI: 10.1097/inf.0000000000004439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
BACKGROUND Staphylococcus aureus is a leading cause of pediatric bacteremia. Persistent S. aureus bacteremia (SAB) is associated with increased morbidity and mortality in adults and children. Risk factors for S. aureus bacteremia have been well established, but there is a limited understanding of the factors that contribute to the development of persistent SAB in children. METHODS This is a single-center retrospective secondary analysis of a prospective observational study of pediatric patients hospitalized with S. aureus infection over a 3.5-year period at a large, quaternary, children's hospital. RESULTS Two hundred fifty-nine children with confirmed S. aureus infection were enrolled in the study. Sixty-five of these were found to have bacteremia, with 28 (43%) developing persistent bacteremia. Patients with persistent SAB were culture-positive for a median of 3.5 days compared with 1 day for those without (P ≤ 0.001). Children with persistent SAB were more likely to have an identified osteoarticular source of infection (93%, n = 26 vs. 62%, n = 23; P = 0.008) and had a shorter median duration to culture positivity than those without persistent SAB (16 hours vs. 20 hours; P ≤ 0.001). In addition, children with persistent SAB had higher median values of presenting erythrocyte sedimentation rate, peak erythrocyte sedimentation rate, presenting C-reactive protein and peak C-reactive protein. Not surprisingly, hospital length of stay was longer in children with persistent SAB compared with those without. CONCLUSIONS These findings suggest that a shorter time to culture positivity, osteoarticular infection, and higher presenting and peak values for select inflammatory markers are potential risk factors for persistent SAB in children.
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Affiliation(s)
- Erin M Thornley
- From the Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Robin Alexander
- Biostatistics Resource at Nationwide Children's Hospital (BRANCH), Columbus, OH
| | - Jill Popelka
- From the Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Christopher P Montgomery
- From the Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH
- Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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Abusheraida NSA, AlBaker AAH, Aljabri ASA, Abdelrahman HA, Al-Mana H, Wilson GJ, Anan KA, Eltai NO. Rapid Visual Detection of Methicillin-Resistant Staphylococcus aureus in Human Clinical Samples via Closed LAMP Assay Targeting mecA and spa Genes. Microorganisms 2024; 12:157. [PMID: 38257983 PMCID: PMC10819026 DOI: 10.3390/microorganisms12010157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
The emergence of antimicrobial resistance (AMR), particularly methicillin-resistant Staphylococcus aureus (MRSA), poses a significant global health threat as these bacteria increasingly become resistant to the most available therapeutic options. Thus, developing an efficient approach to rapidly screen MRSA directly from clinical specimens has become vital. In this study, we establish a closed-tube loop-mediated isothermal amplification (LAMP) method incorporating hydroxy-naphthol blue (HNB) colorimetric dye assay to directly detect MRSA from clinical samples based on the presence of mecA and spa genes. In total, 125 preidentified S. aureus isolates and 93 clinical samples containing S. aureus were sourced from the microbiology laboratory at Hamad General Hospital (HGH). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed based on conventional PCR. The assay demonstrated 100% specificity, 91.23% sensitivity, 0.90 Cohen Kappa (CK), 100% PPV, and 87.8% NPV for the clinical samples, while clinical isolates exhibited 100% specificity, 97% sensitivity, 0.926 CK, 100% PPV, and 88.89% NPV. Compared to cefoxitin disk diffusion, LAMP provided 100% specificity and sensitivity, 1.00 CK, and 100% for PPV and NPV. The study revealed that the closed-tube LAMP incorporating (HNB) dye is a rapid technique with a turnaround time of less than 1 h and high specificity and sensitivity.
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Affiliation(s)
- Noora S. A. Abusheraida
- College of Health Science, Qatar University, Doha P.O. Box 2713, Qatar; (N.S.A.A.); (A.A.H.A.); (A.S.A.A.)
| | - Asraa A. H. AlBaker
- College of Health Science, Qatar University, Doha P.O. Box 2713, Qatar; (N.S.A.A.); (A.A.H.A.); (A.S.A.A.)
| | - Asmaa S. A. Aljabri
- College of Health Science, Qatar University, Doha P.O. Box 2713, Qatar; (N.S.A.A.); (A.A.H.A.); (A.S.A.A.)
| | - Hana A. Abdelrahman
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar; (H.A.A.); (H.A.-M.)
| | - Hassan Al-Mana
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar; (H.A.A.); (H.A.-M.)
| | - Godwin J. Wilson
- Laboratory Medicine and Pathology, Hamad General Hospital, Doha P.O. Box 3050, Qatar;
| | | | - Nahla O. Eltai
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar; (H.A.A.); (H.A.-M.)
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陈 建, 王 旭, 李 文, 陈 敏, 周 俊, 姚 振, 傅 锦, 叶 小. [Screening of pathogenic molecular markers of Staphylococcus aureus in children based on whole genome sequencing technology]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:1161-1169. [PMID: 37990462 PMCID: PMC10672960 DOI: 10.7499/j.issn.1008-8830.2304128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/08/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To explore the molecular characteristics of Staphylococcus aureus (S. aureus) in children, and to compare the molecular characteristics of different types of strains (infection and colonization strains) so as to reveal pathogenic molecular markers of S. aureus. METHODS A cross-sectional study design was used to conduct nasopharyngeal swab sampling from healthy children in the community and clinical samples from infected children in the hospital. Whole genome sequencing was used to detect antibiotic resistance genes and virulence genes. A random forest method to used to screen pathogenic markers. RESULTS A total of 512 S. aureus strains were detected, including 272 infection strains and 240 colonization strains. For virulence genes, the carrying rates of enterotoxin genes (seb and sep), extracellular enzyme coding genes (splA, splB, splE and edinC), leukocytotoxin genes (lukD, lukE, lukF-PV and lukS-PV) and epidermal exfoliating genes (eta and etb) in infection strains were higher than those in colonization strains. But the carrying rates of enterotoxin genes (sec, sec3, seg, seh, sei, sel, sem, sen, seo and seu) were lower in infection strains than in colonization strains (P<0.05). For antibiotic resistance genes, the carrying rates of lnuA, lnuG, aadD, tetK and dfrG were significantly higher in infection strains than in colonization strains (P<0.05). The accuracy of cross-validation of the random forest model for screening pathogenic markers of S. aureus before and after screening was 69% and 68%, respectively, and the area under the curve was 0.75 and 0.70, respectively. The random forest model finally screened out 16 pathogenic markers (sem, etb, splE, sep, ser, mecA, lnuA, sea, blaZ, cat(pC233), blaTEm-1A, aph(3')-III, ermB, ermA, ant(9)-Ia and ant(6)-Ia). The top five variables in the variable importance ranking were sem (OR=0.40), etb (OR=3.95), splE (OR=1.68), sep (OR=3.97), and ser (OR=1.68). CONCLUSIONS The random forest model can screen out pathogenic markers of S. aureus and exhibits a superior predictive performance, providing genetic evidence for tracing highly pathogenic S. aureus and conducting precise targeted interventions.
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Sun C, Tan D, Yu J, Liu J, Shen D, Li S, Zhao S, Zhang L, Li H, Cai K, Xu S, Huang L. Predictive models for sepsis in children with Staphylococcus aureus bloodstream infections: a retrospective cohort study. BMC Pediatr 2023; 23:496. [PMID: 37784062 PMCID: PMC10544563 DOI: 10.1186/s12887-023-04317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 09/16/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The presence of Staphylococcus aureus in the bloodstream can lead to the development of sepsis; however, the severity and risk factors of the systemic inflammatory response to Staphylococcus aureus bloodstream infections were unclear. This study is aimed to build a model to predict the risk of sepsis in children with Staphylococcus aureus bloodstream infections. METHODS A retrospective analysis of hospitalized pediatric patients diagnosed with Staphylococcus aureus bloodstream infections was performed between January 2013 and December 2019. Each patient was assessed using the pediatric version of the Sequential Organ Failure Assessment score (pSOFA) within 24 h of blood culture collection. A nomogram based on logistic regression models was constructed to predict the risk factors for sepsis in children with Staphylococcus aureus bloodstream infections. It was validated using the area under the receiver-operating characteristic curve (AUC). RESULTS Of the 94 patients included in the study, 35 cases (37.2%) developed sepsis. The pSOFA scores ranged from 0 to 8, with 35 patients having a pSOFA score of ≥ 2. Six children (6.4%) died within 30 days, who were all from the sepsis group and had different pSOFA scores. The most common organs involved in sepsis in children with staphylococcal bloodstream infections were the neurologic system (68.6%), respiratory system (48.6%), and coagulation system (45.7%). Hospital-acquired infections (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.3-7.2), implanted catheters (aOR, 10.4; 95% CI, 3.8-28.4), procalcitonin level ≥ 1.7 ng/mL (aOR, 15.4; 95% CI, 2.7-87.1), and underlying diseases, especially gastrointestinal malformations (aOR, 14.0; 95% CI, 2.9-66.7) were associated with Staphylococcus aureus sepsis. However, methicillin-resistant Staphylococcus aureus infection was not a risk factor for sepsis. The nomogram had high predictive accuracy for the estimation of sepsis risk, with an AUC of 0.85. CONCLUSIONS We developed a predictive model for sepsis in children with Staphylococcus aureus infection.
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Affiliation(s)
- Chen Sun
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
- Department of Infectious Disease, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Dongdong Tan
- Department of Pediatrics, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, Guangxi, China
| | - Jiajia Yu
- Department of Clinical Laboratory, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingxian Liu
- Department of Clinical Laboratory, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dihua Shen
- Department of Pediatric Surgery, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuang Li
- Department of Infectious Disease, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Shiyong Zhao
- Department of Infectious Diseases, Hangzhou Children's Hospital, Hangzhou, China
| | - Liya Zhang
- Department of Infectious Disease, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Huajun Li
- Department of Infectious Disease, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Kang Cai
- Department of Infectious Disease, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Shanshan Xu
- Department of Infectious Disease, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Lisu Huang
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China.
- Department of Infectious Disease, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
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Whittington KJ, Malone SM, Hogan PG, Ahmed F, Flowers J, Milburn G, Morelli JJ, Newland JG, Fritz SA. Staphylococcus aureus Bacteremia in Pediatric Patients: Uncovering a Rural Health Challenge. Open Forum Infect Dis 2023; 10:ofad296. [PMID: 37469617 PMCID: PMC10352649 DOI: 10.1093/ofid/ofad296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/30/2023] [Indexed: 07/21/2023] Open
Abstract
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 to 2019. Exposures included rurality (defined by the Rural-Urban Continuum Code), Area Deprivation Index, and outside hospital (OSH) admission before 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%) vs urban children (29%; P = .02). Children initially admitted to an OSH, vs those presenting directly to SLCH, were more likely to require intensive care unit-level (ICU) care (57% vs 29%; P = .002), have an endovascular source of infection (32% vs 12%; P = .004), have a longer duration of illness before hospital presentation (4.1 vs 3.0 days; P = .04), and have delayed initiation of targeted antibiotic therapy (3.9 vs 2.6 days; P = .01). Multivariable analysis revealed rural residence (adjusted odds ratio [aOR], 2.3; 95% 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. Conclusions Children from rural areas face barriers to specialized health care. These challenges may contribute to severe illness and worse outcomes among children with S. aureus bacteremia.
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Affiliation(s)
- Kyle J Whittington
- Correspondence: Stephanie A. Fritz, MD, MSCI, 660 S. Euclid Avenue, MSC 8116-43-10, St Louis, MO 63110-9872 (); or Kyle Whittington, MD, 660 S. Euclid Avenue, MSC 8116-43-10, St Louis, MO 63110-9872 ()
| | - Sara M Malone
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patrick G Hogan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Faria Ahmed
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - JessieAnn Flowers
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Grace Milburn
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John J Morelli
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jason G Newland
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephanie A Fritz
- Correspondence: Stephanie A. Fritz, MD, MSCI, 660 S. Euclid Avenue, MSC 8116-43-10, St Louis, MO 63110-9872 (); or Kyle Whittington, MD, 660 S. Euclid Avenue, MSC 8116-43-10, St Louis, MO 63110-9872 ()
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Eskander PN, Panchangam C, Dyke PC, Padhye A. Fever of Unknown Origin in a Previously Healthy Child. Clin Pediatr (Phila) 2023; 62:255-260. [PMID: 36028951 DOI: 10.1177/00099228221117631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Chaitanya Panchangam
- Department of Child Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Peter C Dyke
- Department of Child Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Amruta Padhye
- Department of Child Health, School of Medicine, University of Missouri, Columbia, MO, USA
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Wu X, Wang C, He L, Xu H, Jing C, Chen Y, Lin A, Deng J, Cao Q, Deng H, Cai H, Chen Y, Yang J, Zhang T, Huang Y, Hao J, Yu H. Antimicrobial resistance profile of methicillin-resistant Staphylococcus aureus isolates in children reported from the ISPED surveillance of bacterial resistance, 2016-2021. Front Cell Infect Microbiol 2023; 13:1102779. [PMID: 36743309 PMCID: PMC9892648 DOI: 10.3389/fcimb.2023.1102779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious threat to public health worldwide. In December 2015, the Infectious Disease Surveillance of Pediatrics (ISPED) program was organized to monitor bacterial epidemiology and resistance trends in children. Methods This retrospective study was conducted from January 2016-December 2021 on patients at eleven ISPED-group hospitals. Results From 2016-2021, a total of 13024 MRSA isolates were obtained from children. The most common age group for patients with MRSA infection was less than 3 years old, and newborns were an important group affected by MRSA infection. MRSA was most commonly isolated from the lower respiratory, an abscess, a secretion, or blood in neonates and from the lower respiratory, an abscess, or the upper respiratory in non-neonates. All isolates were susceptible to vancomycin and linezolid and resistant to penicillin; additionally, 76.88%, 54.97%, 22.30%, 5.67%, 5.14%, 3.63%, and 1.42% were resistant to erythromycin, clindamycin, tetracycline, levofloxacin, sulfamethoxazole-trimethoprim (TMP-SMX), gentamicin, and rifampin, respectively. Between 2016 and 2021, a significant increase was seen in the levofloxacin- and TMP-SMX-resistance rates (from 5.45% to 7.14% and from 4.67% to 6.50%, respectively) among MRSA isolates, along with a significant decrease in the rates of resistance to erythromycin (from 82.61% to 68.08%), clindamycin (from 60.95% to 46.82%), tetracycline (from 25.37% to 17.13%), gentamicin (from 4.53% to 2.82%), and rifampin (from 1.89% to 0.41%). Discussion The antibiotic-resistance rates varied among MRSA isolated from different sources. Because of the high antibiotic resistance rate to clindamycin, this antibiotic is not recommended for empirical treatment of MRSA infections, especially in osteomyelitis.
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Affiliation(s)
- Xia Wu
- Department of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Chuanqing Wang
- Department of Clinical Laboratory, Children’s Hospital of Fudan University, Shanghai, China
| | - Leiyan He
- Department of Clinical Laboratory, Children’s Hospital of Fudan University, Shanghai, China
| | - Hongmei Xu
- Department of Infectious Diseases, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Chunmei Jing
- Department of Clinical Laboratory, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yinghu Chen
- Department of Infectious Diseases, Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Aiwei Lin
- Department of Infectious Diseases, Qilu Children’s Hospital of Shandong University, Jinan, China
| | - Jikui Deng
- Department of Infectious Diseases, Shenzhen Children’s Hospital, Shenzhen, China
| | - Qing Cao
- Department of Infectious Diseases, Shanghai Children’s Medical Center of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huiling Deng
- Department of Infectious Diseases, Xi’an Children’s Hospital, Xi’an, China
| | - Huijun Cai
- Department of Clinical Laboratory, Xi’an Children’s Hospital, Xi’an, China
| | - Yiping Chen
- Department of Pediatric Infectious Diseases, Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinhong Yang
- Department of Clinical Laboratory, Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ting Zhang
- Department of Gastroenterology and Infectious Diseases, Children’s Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuanyuan Huang
- Department of Pediatrics, Bethune First Hospital of Jilin University, Changchun, China
| | - Jianhua Hao
- Department of Infectious Diseases, Kaifeng Children’s Hospital, Kaifeng, China
| | - Hui Yu
- Department of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, China,*Correspondence: Hui Yu,
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10
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Li Y, Zhu Y, Wan C, Wen Y. Staphylococcus aureus bacteremia complicated with non-traumatic mediastinal abscess in children: A case report. Front Pediatr 2023; 11:1115788. [PMID: 36925664 PMCID: PMC10011612 DOI: 10.3389/fped.2023.1115788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
Background Staphylococcus aureus bacteremia complicated with non-traumatic mediastinal abscess rarely occurs in children. Herein, we report a case of S. aureus bacteremia in a previously healthy 15-month-old boy, which was complicated with a non-traumatic mediastinal abscess, followed by recovery without surgery. Case presentation A previously healthy 15-month-old boy presented to the hospital with a high fever, accompanied by chills, lethargy, tachycardia, tachypnea, and slight cough. Contrast-enhanced computerized tomography revealed mediastinal abscess and blood culture analysis showed the presence of S. aureus which was methicillin-susceptible. With prompt initiation of antibiotic treatment, with appropriate duration, the patient successfully recovered without surgical drainage upon discharge. Conclusions Staphylococcus aureus bacteremia complicated with non-traumatic mediastinal abscess is rare in children, and early recognition and appropriate management are essential for a successful outcome.
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Affiliation(s)
- Yiyuan Li
- Key Laboratory of Women and Children Diseases, Department of Pediatrics, West China Second University Hospital, Sichuan University, Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yu Zhu
- Key Laboratory of Women and Children Diseases, Department of Pediatrics, West China Second University Hospital, Sichuan University, Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Chaomin Wan
- Key Laboratory of Women and Children Diseases, Department of Pediatrics, West China Second University Hospital, Sichuan University, Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yang Wen
- Key Laboratory of Women and Children Diseases, Department of Pediatrics, West China Second University Hospital, Sichuan University, Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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11
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Whittington KJ, Ma Y, Butler AM, Hogan PG, Ahmed F, Flowers J, Milburn G, Morelli JJ, Newland JG, Fritz SA. The impact of infectious diseases consultation for children with Staphylococcus aureus bacteremia. Pediatr Res 2022; 92:1598-1605. [PMID: 35982140 PMCID: PMC9789160 DOI: 10.1038/s41390-022-02251-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/14/2022] [Accepted: 07/27/2022] [Indexed: 12/30/2022]
Abstract
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 to 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. IMPACT In children with Staphylococcus aureus bacteremia, consultation by an infectious diseases (ID) physician improved adherence to established quality-of-care indicators (QCIs). The current literature regarding ID consultation in pediatric S. aureus bacteremia is sparse. Three prior international studies demonstrated improved quality of care with ID consultation, though results were disparate regarding clinical outcomes. This article impacts the current literature by strengthening the evidence that ID consultation in children improves adherence to QCIs, and demonstrates that adherence to QCIs improves clinical outcomes.
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Affiliation(s)
- Kyle J. Whittington
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Yinjiao Ma
- Department of Medicine Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Anne M. Butler
- Department of Medicine Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Patrick G. Hogan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Faria Ahmed
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - JessieAnn Flowers
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Grace Milburn
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - John J. Morelli
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jason G. Newland
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Stephanie A. Fritz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA,Corresponding author: Stephanie A. Fritz, MD, MSCI, 660 S. Euclid Avenue, MSC 8116-43-10, St. Louis, MO 63110-9872, , Phone: (314) 454-6050
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12
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Gan MY, Lee WL, Yap BJ, Seethor STT, Greenberg RG, Pek JH, Tan B, Hornik CPV, Lee JH, Chong SL. Contemporary Trends in Global Mortality of Sepsis Among Young Infants Less Than 90 Days: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:890767. [PMID: 35722477 PMCID: PMC9204066 DOI: 10.3389/fped.2022.890767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Current knowledge on the global burden of infant sepsis is limited to population-level data. We aimed to summarize global case fatality rates (CFRs) of young infants with sepsis, stratified by gross national income (GNI) status and patient-level risk factors. Methods We performed a systematic review and meta-analysis on CFRs among young infants < 90 days with sepsis. We searched PubMed, Cochrane Central, Embase, and Web of Science for studies published between January 2010 and September 2019. We obtained pooled CFRs estimates using the random effects model. We performed a univariate analysis at patient-level and a meta-regression to study the associations of gestational age, birth weight, onset of sepsis, GNI, age group and culture-proven sepsis with CFRs. Results The search yielded 6314 publications, of which 240 studies (N = 437,796 patients) from 77 countries were included. Of 240 studies, 99 were conducted in high-income countries, 44 in upper-middle-income countries, 82 in lower-middle-income countries, 6 in low-income countries and 9 in multiple income-level countries. Overall pooled CFR was 18% (95% CI, 17-19%). The CFR was highest for low-income countries [25% (95% CI, 7-43%)], followed by lower-middle [25% (95% CI, 7-43%)], upper-middle [21% (95% CI, 18-24%)] and lowest for high-income countries [12% (95% CI, 11-13%)]. Factors associated with high CFRs included prematurity, low birth weight, age less than 28 days, early onset sepsis, hospital acquired infections and sepsis in middle- and low-income countries. Study setting in middle-income countries was an independent predictor of high CFRs. We found a widening disparity in CFRs between countries of different GNI over time. Conclusion Young infant sepsis remains a major global health challenge. The widening disparity in young infant sepsis CFRs between GNI groups underscore the need to channel greater resources especially to the lower income regions. Systematic Review Registration [www.crd.york.ac.uk/prospero], identifier [CRD42020164321].
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Affiliation(s)
- Ming Ying Gan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Li Lee
- Duke-NUS Medical School, Singapore, Singapore
| | - Bei Jun Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Rachel G Greenberg
- Department of Paediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Jen Heng Pek
- Emergency Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Bobby Tan
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Christoph Paul Vincent Hornik
- Division of Critical Care Medicine, Department of Paediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Jan Hau Lee
- Duke-NUS Medical School, Singapore, Singapore
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shu-Ling Chong
- Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore
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13
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Stultz JS, Benefield E, Lee KR, Bashqoy F, Pakyz AL. A Multicenter Analysis of Changes in Pediatric Antibiotic Susceptibilities Among Staphylococcus aureus and Pseudomonas aeruginosa Isolates: 2014–2018. J Pediatr Pharmacol Ther 2022; 27:330-339. [DOI: 10.5863/1551-6776-27.4.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/02/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
To describe antibiotic susceptibilities for Staphylococcus aureus and Pseudomonas aeruginosa among pediatric institutions in 2018. To assess correlations between antibiotic utilization and susceptibilities.
METHODS
Institutional antibiograms from 2018 were compiled among 13 institutions via a survey. Resistant pathogens and antibiotic days of therapy/1000 patient days (PD) were collected from 6 institutions over 5 years. Correlations were assessed as pooled data among all institutions and relative changes within individual institutions.
RESULTS
All 8552 S aureus isolates in 2018 were vancomycin susceptible and 40.1% were methicillin resistant (MRSA). Among MRSA, 96.3% and 78.8% were susceptible to trimethoprim/sulfamethoxazole and clindamycin, respectively. Pooled yearly MRSA/1000 PD decreased from 2014–2018 and correlated with pooled yearly decreases in vancomycin utilization (R = 0.983, p = 0.003). Institutional relative decreases in vancomycin utilization from 2014–2018 did not correlate with institutional relative decreases in MRSA susceptibility (R = −0.659, p = 0.16). Susceptibility to meropenem was 90.9% among 2315 P aeruginosa isolates in 2018. Antipseudomonal beta-lactam susceptibility ranged from 89.4% to 92.3%. Pooled yearly meropenem-resistant P aeruginosa/1000 PD and meropenem utilization did not significantly decrease over time or correlate (both p > 0.6). Institutional relative change in meropenem utilization from 2013–2017 correlated with the institutional relative change in P aeruginosa susceptibility to meropenem from 2014–2018 (Rs = −0.89, p = 0.019).
CONCLUSIONS
Among included institutions, the burden of MRSA decreased over time. Institutional MRSA prevalence did not consistently correlate with institutional vancomycin utilization. Institutional changes in meropenem utilization correlated with P aeruginosa susceptibility the following year. Pooled analyses did not illustrate this correlation, likely owing to variability in utilization between institutions.
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Affiliation(s)
- Jeremy S. Stultz
- Department of Clinical Pharmacy and Translational Science (JSS, KRL), The University of Tennessee Health Science Center College of Pharmacy, Memphis, TN
- Department of Pharmacy (JSS, KRL), Le Bonheur Children's Hospital, Memphis, TN
| | - Emily Benefield
- Department of Pharmacy (EB), Primary Children's Hospital, Salt Lake City, UT
| | - Kelley R. Lee
- Department of Clinical Pharmacy and Translational Science (JSS, KRL), The University of Tennessee Health Science Center College of Pharmacy, Memphis, TN
- Department of Pharmacy (JSS, KRL), Le Bonheur Children's Hospital, Memphis, TN
| | - Ferras Bashqoy
- Department of Pharmacy (FB), Hassenfeld Children's Hospital at NYU Langone Health, New York, NY
| | - Amy L. Pakyz
- Department of Pharmacotherapy and Outcomes Science (ALP), Virginia Commonwealth University School of Pharmacy, Richmond, VA
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14
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Aguilera-Alonso D, Kirchschläger Nieto S, Ara Montojo MF, Sanz Santaeufemia FJ, Saavedra-Lozano J, Soto B, Caminoa MB, Berzosa A, Prieto Tato L, Cercenado E, Tagarro A, Molina Arana D, Alonso Sanz M, Romero Gómez MP, Chaves Sánchez F, Baquero-Artigao F. Staphylococcus aureus Community-acquired Pneumonia in Children After 13-Valent Pneumococcal Vaccination (2008-2018): Epidemiology, Clinical Characteristics and Outcomes. Pediatr Infect Dis J 2022; 41:e235-e242. [PMID: 35333816 DOI: 10.1097/inf.0000000000003503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The epidemiology of community-acquired pneumonia (CAP) has changed, influenced by sociosanitary conditions and vaccination status. We aimed to analyze the recent epidemiology of bacterial CAP in hospitalized children in a setting with high pneumococcal vaccination coverage and to describe the clinical characteristics of pediatric Staphylococcus aureus CAP. METHODS Children <17 years old hospitalized from 2008 to 2018 with bacterial CAP in 5 tertiary hospitals in Spain were included. Cases with pneumococcal CAP were randomly selected as comparative group following a case-control ratio of 2:1 with S. aureus CAP. RESULTS A total of 313 bacterial CAP were diagnosed: Streptococcus pneumoniae CAP (n = 236, 75.4%), Streptococcus pyogenes CAP (n = 43, 13.7%) and S. aureus CAP (n = 34, 10.9%). Throughout the study period, the prevalence of S. pyogenes increased (annual percentage change: +16.1% [95% CI: 1.7-32.4], P = 0.031), S. pneumoniae decreased (annual percentage change: -4.4% [95 CI: -8.8 to 0.2], P = 0.057) and S. aureus remained stable. Nine isolates of S. aureus (26.5%) were methicillin-resistant. Seventeen cases (50%) with S. aureus CAP had some pulmonary complication and 21 (61.7%) required intensive care. S. pneumoniae CAP showed a trend toward higher prevalence of pulmonary complications compared with S. aureus CAP (69.1% vs. 50.0%, P = 0.060), including higher frequency of pulmonary necrosis (32.4% vs. 5.9%, P = 0.003). CONCLUSIONS The incidence of S. aureus CAP in children remained stable, whereas the prevalence of pneumococcal CAP decreased and S. pyogenes CAP increased. Patients with S. aureus presented a high frequency of severe outcomes, but a lower risk of pulmonary complications than patients with S. pneumoniae.
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Affiliation(s)
- David Aguilera-Alonso
- From the Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Jesús Saavedra-Lozano
- From the Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Soto
- Department of Pediatrics, Hospital de Getafe, Madrid, Spain
| | | | - Arantxa Berzosa
- Department of Pediatrics, Hospital Clinico San Carlos, Madrid, Spain
| | - Luis Prieto Tato
- Department of Pediatric Infectious Diseases, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Emilia Cercenado
- Department of Microbiology, Hospital General Universitario Gregorio Marañón, CIBERES, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Alfredo Tagarro
- Department of Pediatrics, Hospital Infanta Sofía, Madrid, Spain
| | | | | | - María Pilar Romero Gómez
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
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15
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Kalu IC, Kao CM, Fritz SA. Management and Prevention of Staphylococcus aureus Infections in Children. Infect Dis Clin North Am 2022; 36:73-100. [PMID: 35168715 PMCID: PMC9901217 DOI: 10.1016/j.idc.2021.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Staphylococcus aureus is a common skin commensal with the potential to cause severe infections resulting in significant morbidity and mortality. Up to 30% of individuals are colonized with S aureus, though infection typically does not occur without skin barrier disruption. Infection management includes promptly addressing the source of infection, including sites of metastatic infection, and initiation of effective antibiotics, which should be selected based on local antibiotic susceptibility patterns. Given that S aureus colonization is a risk factor for infection, preventive strategies are aimed at optimizing hygiene measures and decolonization regimens for outpatients and critically ill children with prolonged hospitalizations.
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Affiliation(s)
| | | | - Stephanie A. Fritz
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
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16
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Inagaki K, Ansari MAY, Hobbs CV. Readmission after hospitalization with Staphylococcus aureus bacteremia in children. Am J Infect Control 2021; 49:1402-1407. [PMID: 33989724 DOI: 10.1016/j.ajic.2021.04.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Readmission rate is an important quality measure and can inform patient care. However, readmission of S. aureus bacteremia in children requires further research. METHODS We performed a population-based longitudinal observational study using the State Inpatient Database from New York, Florida, and Washington, 2009-2015. Children aged 18 years or younger hospitalized with S. aureus bacteremia were included. The outcome of non-elective readmission was assessed by developing Cox proportional hazards regression models. RESULTS Of 1240 children with S. aureus bacteremia, 223 (18.0%) and 351 (28.3%) had non-elective readmission within 30 days and 90 days after discharge, respectively. On multivariable analysis, catheter related infection (hazard ratio, HR: 1.79, 95% confidence interval, CI: 1.31-2.45) was associated with 30-day readmission. The median cost of the original hospitalization for S. aureus bacteremia was $29 914 (interquartile range, IQR: $13 276-$71 284), and that of 30 day readmission was $10 956 (IQR: $5765-$24 753). CONCLUSIONS S. aureus bacteremia is associated with a high rate of readmission in children, particularly in those with catheter related infection. Hospitalization with S. aureus bacteremia and readmission are costly. Future research should seek interventions to improve outcomes of S. aureus bacteremia in children, and the results of this study can serve as a benchmark.
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Affiliation(s)
- Kengo Inagaki
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA; Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA.
| | - Md Abu Yusuf Ansari
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Charlotte V Hobbs
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
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17
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Campbell AJ, Al Yazidi LS, Phuong LK, Leung C, Best EJ, Webb RH, Voss L, Athan E, Britton PN, Bryant PA, Butters CT, Carapetis JR, Ching NS, Coombs GW, Daley D, Francis J, Hung TY, Mowlaboccus S, Nourse C, Ojaimi S, Tai A, Vasilunas N, McMullan B, Blyth CC, Bowen AC. Pediatric Staphylococcus aureus bacteremia: clinical spectrum and predictors of poor outcome. Clin Infect Dis 2021; 74:604-613. [PMID: 34089594 DOI: 10.1093/cid/ciab510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 11/14/2022] Open
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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Affiliation(s)
- Anita J Campbell
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.,School of Medicine, University of Western Australia, Perth, Australia
| | - Laila S Al Yazidi
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.,Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia.,The Children's Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, NSW, Australia
| | - Linny K Phuong
- Department of General Medicine, Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia.,Infection and Immunity Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Clare Leung
- Department of Paediatrics, Wagga Wagga Base Hospital, New South Wales, Australia
| | - Emma J Best
- Department of Paediatrics; Child and Youth Health, The University of Auckland.,The National Immunisation Advisory Centre, The University of Auckland.,Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Rachel H Webb
- Department of Paediatrics; Child and Youth Health, The University of Auckland.,Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics, Kidz First Hospital, Auckland, New Zealand
| | - Lesley Voss
- Department of Paediatrics; Child and Youth Health, The University of Auckland.,Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Eugene Athan
- Department of Infectious Disease, Barwon Health, Geelong, Australia.,School of Medicine, Deakin University, Geelong, Australia
| | - Philip N Britton
- Sydney Medical School and Marie Bashir Institute, University of Sydney, NSW, Australia.,Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, Sydney, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Coen T Butters
- Infectious Diseases Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jonathan R Carapetis
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia.,University of Western Australia. School of Medicine, Perth, Western, Australia
| | - Natasha S Ching
- Department of General Paediatrics, Monash Children's Hospital, Monash Health, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Australia
| | - Geoffrey W Coombs
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Royal Perth Hospital and Fiona Stanley Hospital, Western Australia.,Antimicrobial Resistance and Infectious Diseases Research (AMRID) Laboratory, Murdoch University, Perth, Western Australia
| | - Denise Daley
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Royal Perth Hospital and Fiona Stanley Hospital, Western Australia.,The Australian Group on Antimicrobial Resistance (AGAR)
| | - Joshua Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Te-Yu Hung
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.,Doherty Institute of Infection and Immunity, The Royal Melbourne Hospital, The University of Melbourne
| | - Shakeel Mowlaboccus
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch.,School of Biomedical Sciences, University of Western Australia, Nedlands
| | - Clare Nourse
- Queensland Children's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Australia
| | - Samar Ojaimi
- Infection & Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia.,Department of Pediatrics, Monash University, Clayton, Australia
| | - Alex Tai
- Department of Infectious Disease, Barwon Health, Geelong, Australia
| | - Nan Vasilunas
- Infectious Diseases Department, Women's and Children's Hospital, Adelaide
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia.,National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia.,Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute.,School of Medicine, University of Western Australia, Subiaco.,Menzies School of Health Research, Charles Darwin Hospital, Darwin, NT
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Reduced Vancomycin Susceptibility, MRSA and Treatment Failure in Pediatric Staphylococcus aureus Bloodstream Infections. Pediatr Infect Dis J 2021; 40:429-433. [PMID: 33196562 PMCID: PMC8592063 DOI: 10.1097/inf.0000000000002992] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clinical implications of reduced vancomycin susceptibility (RVS) among pediatric Staphylococcus aureus bloodstream infections are unknown. METHODS We identified all children at 2 children's hospitals with ≥1 blood culture positive for S. aureus. We compared patient and clinical factors for RVS and non-RVS infections using Wilcoxon rank-sum and chi-squared tests. Treatment failure and the duration of bacteremia for RVS versus non-RVS and for methicillin-resistant Staphylococcus aureus (MRSA) versus methicillin-susceptible Staphylococcus aureus (MSSA) infections were compared using multivariable logistic and Poisson regressions, respectively. For MRSA infections, the association of empiric vancomycin monotherapy with treatment failure was assessed using multivariable logistic regression. RESULTS RVS was present in 72% (309/426) of cases. No patient or infection characteristics, including methicillin resistance, were associated with RVS. RVS was associated with an increased duration of bacteremia compared with non-RVS infections, aIRR = 1.15 (95% confidence interval: 1.02-1.30). The odds of treatment failure was similar for RVS and non-RVS infections, aOR = 1.04 (0.62-1.74). In contrast, MRSA infections were more likely to have treatment failure than MSSA infections, aOR = 3.03 (95% confidence interval: 1.84-5.00). For MRSA infections, empiric vancomycin monotherapy was associated with an increased odds of treatment failure compared with non-vancomycin or combination anti-MRSA antibiotics, aOR = 3.23 (1.12-9.26). CONCLUSIONS RVS was common and was associated with a longer duration of bacteremia but not with treatment failure. Treatment failure was more common for MRSA than for MSSA bloodstream infections. Empiric vancomycin monotherapy increased the odds of treatment failure for MRSA infections.
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Lloyd EC, Martin ET, Dillman N, Nagel J, Chang R, Gandhi TN, Tribble AC. Impact of a Best Practice Advisory for Pediatric Patients With Staphylococcus aureus Bacteremia. J Pediatric Infect Dis Soc 2021; 10:282-288. [PMID: 32531048 DOI: 10.1093/jpids/piaa058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/12/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Infectious diseases (ID) consultation and optimal antibiotic therapy improve outcomes in Staphylococcus aureus bacteremia (SAB). Data on strategies to improve adherence to these practices in children are limited. METHODS This was a quasi-experimental study evaluating the impact of an electronic medical record (EMR)-based best practice advisory (BPA) for SAB, recommending ID consult and optimal antibiotic therapy based on rapid mecA gene detection. Inpatients < 21 years old with SAB before (January 2015-July 2017) and after (August 2017-December 2018) BPA implementation were included. Primary outcome was receipt of ID consult. Secondary outcomes included receipt of optimal therapy, time to ID consult and optimal therapy, recurrent SAB, and 30-day all-cause mortality. ID consultation rates pre- and postimplementation were compared using interrupted time series (ITS) analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) for time to optimal therapy were calculated using Cox regression. RESULTS We included 99 SAB episodes (70 preintervention, 29 postintervention). Preintervention, 48 (68.6%) patients received an ID consult compared to 27 (93.1%) postintervention, but this was not statistically significant on ITS analysis due to a preexisting trend of increasing consultation. Median hours to optimal therapy decreased from 26.1 to 5.5 (P = .03), most notably in patients with methicillin-sensitive S. aureus (MSSA) (42.2 to 10.8; P < .01). On Cox regression, BPA implementation was associated with faster time to optimal therapy (HR, 3.22 [95% CI, 1.04-10.01]). CONCLUSIONS Implementation of an EMR-based BPA for SAB resulted in faster time to optimal antibiotic therapy, particularly for patients with MSSA. ID consultation increased throughout the study period and was not significantly impacted by the BPA.
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Affiliation(s)
- Elizabeth C Lloyd
- Division of Pediatric Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Emily T Martin
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Nicholas Dillman
- Department of Pharmacy, University of Michigan, Ann Arbor, Michigan
| | - Jerod Nagel
- Department of Pharmacy, University of Michigan, Ann Arbor, Michigan
| | - Robert Chang
- Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan
| | - Tejal N Gandhi
- Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Alison C Tribble
- Division of Pediatric Infectious Diseases, University of Michigan, Ann Arbor, Michigan
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Welch SN, Patel RM, Morris LE, Dassner AM, Rozario NL, Forrester JB. Impact of antimicrobial stewardship and rapid diagnostics in children with
Staphylococcus aureus
bacteremia. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Stephanie N. Welch
- Department of Pharmacy Atrium Health Carolinas Medical Center Charlotte North Carolina USA
| | - Rupal M. Patel
- Antimicrobial Support Network Atrium Health Levine Children's Hospital Charlotte North Carolina USA
| | - Lee E. Morris
- Department of Pediatric Infectious Diseases Atrium Health Levine Children's Hospital Charlotte North Carolina USA
| | - Aimee M. Dassner
- Department of Pharmacy Children's Medical Center of Dallas Dallas Texas USA
| | - Nigel L. Rozario
- Center for Outcomes Research and Evaluation Atrium Health Charlotte North Carolina USA
| | - Jeanne B. Forrester
- Antimicrobial Support Network Atrium Health Levine Children's Hospital Charlotte North Carolina USA
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Congedi S, Minotti C, Giaquinto C, Da Dalt L, Donà D. Acute infectious osteomyelitis in children: new treatment strategies for an old enemy. World J Pediatr 2020; 16:446-455. [PMID: 32394145 DOI: 10.1007/s12519-020-00359-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 03/17/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute osteomyelitis still represents a significant clinical challenge, with an increasing incidence in paediatric population. A careful assessment and a rapid diagnosis with proper timing and choice of empirical antimicrobial therapy are necessary to avoid sequelae. The initial treatment should consist of empirical antibiotic therapy, to cover the major responsible pathogens in each age group. DATA SOURCES We made a literature search with PubMed and Cochrane database from 2000 to 2019 in English, French, and Spanish languages using the key words "osteomyelitis, children, clinical, diagnosis, and treatment". RESULTS The child's clinical features, age, and the microbiological profile of the geographic area should be evaluated for diagnosis and in the choice of antibiotic treatment. Latest data suggest the administration of intravenous antibiotics for a short period, with subsequent oral therapy, according to the improvement of clinical status and inflammatory markers. For children older than 3 months, the shift to oral medications is already possible after a short course of intravenous therapy, until recovery. The timing for the shift from cefazolin to cephalexin or cefuroxime, intravenous clindamycin to oral clindamycin, and intravenous ceftriaxone + oxacillin to oral equivalents will be decided according to the improvement of clinical status and inflammatory markers. We also present the approach to osteomyelitis due to difficult pathogens, such as Methicillin-resistant Staphylococcus aureus (MRSA) and Panton-Valentine leukocidin (PVL)-positive S. aureus infections. CONCLUSION In this review, we present the current approach to the clinical diagnosis and management of osteomyelitis in childhood, with an update on recent recommendations, as a useful instrument to understand the rationale of antibiotic therapy.
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Affiliation(s)
- Sabrina Congedi
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Chiara Minotti
- Department of Women's and Children's Health, University of Padua, Padua, Italy.
| | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Paediatric Emergency Department, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
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Paradoxical Antibiotic Effect of Ampicillin: Use of a Population Pharmacokinetic Model to Evaluate a Clinical Correlate of the Eagle Effect in Infants With Bacteremia. Pediatr Infect Dis J 2020; 39:725-729. [PMID: 32235247 PMCID: PMC8628496 DOI: 10.1097/inf.0000000000002663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND High doses of ampicillin are often used to achieve therapeutic drug concentrations in infants. A paradoxical antibiotic effect, often called the Eagle effect, occurs when increasing concentrations of antibiotic above a threshold results in decreased efficacy. It is unknown if infants treated with ampicillin are at risk for this paradoxical effect. METHODS We identified infants <28 days of age with Escherichia coli, Enterococcus or Streptococcus agalactiae (group B streptococcus) bloodstream infections from 1997 to 2012 and previously included in an ampicillin pharmacokinetic (PK) modeling study. We compared the odds of death for ampicillin dose, estimated time above the minimum inhibitory concentration (T > MIC) and PK parameters using separate logistic regression models. Adjusted logistic regression and Poisson models were used to calculate the odds of prolonged bacteremia ≥3 days and the duration of bacteremia, respectively, for dose, T > MIC and multiple PK parameters. RESULTS Among 1272 infants meeting inclusion criteria, odds of death 7 or 30 days after the positive blood culture were not consistent with a paradoxical effect across any of the dosing regimens or PK parameters evaluated. The odds of prolonged bacteremia was lowest at the lowest dose category and the lowest daily dose category but not associated with the area-under-the-concentration time curve from 0 to 24 hours, or the maximum or minimum concentrations at steady state. T > MIC of ≥50% of the dosing interval was associated with decreased duration of bacteremia and odds of prolonged bacteremia. CONCLUSIONS It is unlikely that a paradoxical antibiotic effect will have a clinical correlate when ampicillin is used for neonatal bacteremia. A T > MIC ≥50% decreased both duration of bacteremia and odds of prolonged bacteremia.
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Waitayangkoon P, Thongkam A, Benjamungkalarak T, Rachayon M, Thongthaisin A, Chatsuwan T, Thammahong A, Chiewchengchol D. Hospital epidemiology and antimicrobial susceptibility of isolated methicillin-resistant Staphylococcus aureus: a one-year retrospective study at a tertiary care center in Thailand. Pathog Glob Health 2020; 114:212-217. [PMID: 32379543 DOI: 10.1080/20477724.2020.1755550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Increased rates of Staphylococcus aureus resistance and its morbidity and mortality have raised concern about the strategy of antibiotic use. OBJECTIVES This study aimed to determine the prevalence of methicillin-resistant S. aureus (MRSA) and vancomycin-resistant S. aureus (VRSA) isolates among Thai patients with S. aureus infection and to identify risk factors and appropriate antibiotics for these resistant strains. METHODS Data of culture-proven S. aureus isolates from clinical specimens during 2017 in King Chulalongkorn Memorial Hospital, Thailand, were retrospectively collected and classified as methicillin-sensitive S. aureus or MRSA by cefoxitin screening and oxacillin minimum inhibitory concentration by the Vitek 2 system. Each isolate was also tested for susceptibility to teicoplanin, erythromycin, clindamycin, linezolid, trimethoprim/sulfamethoxazole, ciprofloxacin, moxifloxacin, tetracycline, doxycycline, and vancomycin by Vitek 2. Demographic information and comorbidities from medical records were reviewed to identify risk factors for S. aureus infection. RESULTS MRSA isolates were identified in 147 (17%) of 890 patients with no different ratio in adults or children. A higher proportion of MRSA in hospital-acquired settings was observed (27% vs. 12%; p < 0.001). Comorbidities significantly associated with MRSA were chronic lung, cardiovascular, and neurological diseases. Atrial fibrillation, dementia, and benign prostatic hyperplasia were independently associated with MRSA isolation. Vancomycin was still susceptible to all kinds of infection. One VRSA isolate was from colonization. CONCLUSION The prevalence of MRSA in our facility seemed to be comparatively low. Vancomycin is still an appropriate option for MRSA coverage since all S. aureus isolates in our center were sensitive to vancomycin. However, careful attention is warranted since one colonization isolate was VRSA.
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Affiliation(s)
- Palapun Waitayangkoon
- Translational Research in Inflammation and Immunology Research Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand.,Antimicrobial Resistance and Stewardship Research Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand
| | - Achitpol Thongkam
- Translational Research in Inflammation and Immunology Research Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand
| | - Tanawat Benjamungkalarak
- Translational Research in Inflammation and Immunology Research Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand
| | - Muanpetch Rachayon
- Translational Research in Inflammation and Immunology Research Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand
| | - Aphisit Thongthaisin
- Translational Research in Inflammation and Immunology Research Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand
| | - Tanittha Chatsuwan
- Antimicrobial Resistance and Stewardship Research Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand
| | - Arsa Thammahong
- Antimicrobial Resistance and Stewardship Research Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand
| | - Direkrit Chiewchengchol
- Translational Research in Inflammation and Immunology Research Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand.,Antimicrobial Resistance and Stewardship Research Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand
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