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Suárez-Bustamante Huélamo M, Alonso-Cadenas JA, Cortés BG, Goikoetxea IG, Hernández-Bou S, de la Torre Espí M. Staphylococcus aureus Bacteremia in the Pediatric Emergency Department and Predictors of Poor Outcome. Pediatr Infect Dis J 2023; 42:954-959. [PMID: 37523577 DOI: 10.1097/inf.0000000000004053] [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: 08/02/2023]
Abstract
BACKGROUND Staphylococcus aureus has become the leading cause of bacteremia among previously healthy children older than 5 years. METHODS We aimed to describe the infants presenting to pediatric emergency departments and diagnosed with S. aureus bacteremia (SAB) and identify predictors (clinical and laboratory variables) of poor outcome (complications, sequelae or death). We performed an observational study and subanalysis of a multicenter prospective registry, including every patient under the age of 18 years with a positive blood culture obtained at any of the 22 participating Spanish pediatric emergency departments between 2011 and 2016. We considered chronic diseases, immunosuppressive treatment and the presence of mechanical devices as risk factors for SAB. RESULTS Of the 229 patients with SAB, 176 (76.9%) were previously healthy, 192 (83.8%) had a normal pediatric assessment triangle and 158 (69.0%) had an associated focal infection (mainly osteoarticular infection, skin and soft tissue infection and pneumonia). Fifty-three patients (23.1%) had 1 or more risk factors for SAB. Thirty-one (13.5%) presented a poor outcome, including 4 deaths (1.7%). A poor outcome was more common in patients with SAB risk factors [odds ratio (OR): 7.0; 95% CI: 3.2-15.4], abnormal PAT (OR: 5.9; 95% CI: 2.6-13.3), elevated procalcitonin (OR: 1.2; 95% CI: 1.05-1.3) and C-reactive protein, the latter being the only independent predictor of poor outcome (OR: 1.01; 95% CI: 1.01-1.02). CONCLUSIONS Overall, children with SAB are previously healthy, appear well, and have an associated focal infection. One of 7 had a poor outcome, with C-reactive protein being the only predictor identified.
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Affiliation(s)
| | | | - Borja Gómez Cortés
- Pediatric Emergency Department, Hospital Cruces (Barakaldo), Vizcaya, Spain
| | | | - Susanna Hernández-Bou
- Pediatric Emergency Department, Hospital Sant Joan de Déu de Barcelona (Esplugues de Llobregat), Barcelona, Spain
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2
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McGarry ME, Huang CY, Ly NP. Ethnic differences in staphylococcus aureus acquisition in cystic fibrosis. J Cyst Fibros 2023; 22:909-915. [PMID: 37460380 PMCID: PMC10802839 DOI: 10.1016/j.jcf.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Hispanic people with CF (pwCF) have increased morbidity than non-Hispanic White pwCF, including increased risk of Pseudomonas aeruginosa. We aimed to determine if Staphylococcus aureus (S. aureus) acquisition varies between Hispanic and non-Hispanic White pwCF. METHODS This longitudinal cohort study of pwCF ages 0-25 years in the CF Foundation Patient Registry compared acquisition of methicillin-sensitive S. aureus (MSSA), methicillin-resistant S. aureus (MRSA), persistent MRSA between Hispanic and non-Hispanic White pwCF. Risk of acquisition was assessed by Kaplan-Meier survival curves and its association with ethnicity was evaluated using Cox regressions. Adjusted associations were evaluated using multivariate Cox models adjusting for sex, age of entry into CFFPR, CFTR variant severity, pancreatic insufficiency, CF-related diabetes, maternal education, insurance status. RESULTS Of 10,640 pwCF, 7.5% were Hispanic and 92.5% were non-Hispanic White. Hispanic pwCF had a 19% higher risk of acquiring MSSA (HR 1.19, 95% CI 1.10-1.28, p<0.001) and 13% higher risk of acquiring MRSA (HR 1.13, 95% CI 1.02-1.26, p = 0.02) than non-Hispanic White pwCF. The difference in persistent MRSA between ethnicities did not reach statistical significance. After adjusting for confounding variables, only the risk of MSSA was significantly associated with ethnicity. Compared to non-Hispanic White pwCF, Hispanic pwCF acquired MSSA and MRSA at younger median ages (4.9 vs. 3.8 years (p<0.001), 22.4 vs. 20.8 years (p = 0.02). CONCLUSION Hispanic pwCF <25 years of age have an increased risk of acquiring MSSA and acquired MSSA and MRSA at an earlier age. Differences in S. aureus acquisition may contribute to increased morbidity in Hispanic pwCF.
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Affiliation(s)
- Meghan E McGarry
- Division of Pediatric Pulmonology, Department of Pediatrics, University of California, 550 16th Ave, Box 0632, San Francisco, CA 94158, United States.
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
| | - Ngoc P Ly
- Division of Pediatric Pulmonology, Department of Pediatrics, University of California, 550 16th Ave, Box 0632, San Francisco, CA 94158, United States
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3
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See P, Bonacorsi S, Toumazi A, Doit C, Naudin J, Chomton M, Le Bourgeois F, Caseris M, Mariani-Kurkdjian P, Poncelet G, Geslain G, Dauger S, Levy M. Factors linked to Staphylococcus aureus healthcare-associated infections among pediatric intensive care unit colonized patients. Arch Pediatr 2023; 30:153-157. [PMID: 36822930 DOI: 10.1016/j.arcped.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 10/20/2022] [Accepted: 01/29/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Staphylococcus aureus (SA) is one of the main pathogens responsible for healthcare-associated infection (HCAI) in pediatrics. The aim of this study was to describe the prevalence of SA-HCAI among colonized patients and the factors associated with it in the pediatric intensive care unit (PICU). METHODS We designed a 6-year retrospective cohort study of a PICU in a French university children's hospital including all children admitted to the PICU from January 1, 2011, to December 31, 2016, who had SA colonization on PICU admission. For each patient, the past medical history and the hospitalization data were collected. HCAIs related to SA were verified according to the criteria of the United States Centers for Disease Control and Prevention. RESULTS Among all patients colonized with SA (n = 1381, 26%), 105 (8%) had methicillin-resistant SA carriage and 41 (3%) developed an HCAI caused by SA. The main HCAIs were ventilator-associated pneumonia (51%) and central line-associated bloodstream infections (27%). Patients developing HCAI caused by SA had a significantly longer length of hospital stay and a higher mortality rate than the rest of the population. Using a multivariate logistic regression model, the presence of mechanical ventilation, the implementation of a surgical procedure during the PICU stay, and the onset of at least one episode of anemia during the PICU stay were significantly associated with the occurrence of HCAI due to SA. CONCLUSION HCAIs linked to SA carriage are rare but severe. Mechanical ventilation, surgery during the PICU stay, and anemia are factors associated with SA-HCAI.
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Affiliation(s)
- Perrine See
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Stéphane Bonacorsi
- Microbiology Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Artemis Toumazi
- Unit of Clinical Epidemiology, Inserm U1123 and CIC-EC 1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Catherine Doit
- Microbiology Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jérôme Naudin
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Maryline Chomton
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Fleur Le Bourgeois
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Marion Caseris
- Paediatric Infectious Disease Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Patricia Mariani-Kurkdjian
- Microbiology Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Géraldine Poncelet
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Guillaume Geslain
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Stéphane Dauger
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Michael Levy
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.
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4
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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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5
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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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6
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Genomic and Epidemiological Features of Two Dominant Methicillin-Susceptible Staphylococcus aureus Clones from a Neonatal Intensive Care Unit Surveillance Effort. mSphere 2022; 7:e0040922. [PMID: 36218345 PMCID: PMC9769867 DOI: 10.1128/msphere.00409-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Methicillin-susceptible Staphylococcus aureus (MSSA) is a more prevalent neonatal intensive care unit (NICU) pathogen than methicillin-resistant S. aureus (MRSA). However, the introduction and spread of MSSA, the role of systematic decolonization, and optimal infection prevention and control strategies remain incompletely understood. We previously screened infants hospitalized in a university-affiliated level III to IV NICU twice monthly over 18 months for S. aureus colonization and identified several prevalent staphylococcal protein A (spa) types. Here, we performed whole-genome sequencing (WGS) and phylogenetic comparisons of 140 isolates from predominant spa types t279, t1451, and t571 to examine possible transmission routes and identify genomic and epidemiologic features associated with the spread of dominant clones. We identified two major MSSA clones: sequence type 398 (ST398), common in the local community, and ST1898, not previously encountered in the region. ST398 NICU isolates formed distinct clusters with closely related community isolates from previously published data sets, suggesting multiple sources of acquisition, such as family members or staff, including residents of the local community. In contrast, ST1898 isolates were nearly identical, pointing to clonal expansion within the NICU. Almost all ST1898 isolates harbored plasmids encoding mupirocin resistance (mupA), suggesting an association between the proliferation of this clone and decolonization efforts with mupirocin. Comparative genomics indicated genotype-specific pathways of introduction and spread of MSSA via community-associated (ST398) or health care-associated (ST1898) sources and the potential role of mupirocin resistance in dissemination of ST1898. Future surveillance efforts could benefit from routine genotyping to inform clone-specific infection prevention strategies. IMPORTANCE Methicillin-susceptible Staphylococcus aureus (MSSA) is a significant pathogen in neonates. However, surveillance efforts in neonatal intensive care units (NICUs) have focused primarily on methicillin-resistant S. aureus (MRSA), limiting our understanding of colonizing and infectious MSSA clones which are prevalent in the NICU. Here, we identify two dominant colonizing MSSA clones during an 18-month surveillance effort in a level III to IV NICU, ST398 and ST1898. Using genomic surveillance and phylogenetic analysis, coupled with epidemiological investigation, we found that these two sequence types had distinct modes of spread, namely the suggested exchange with community reservoirs for ST398 and the contribution of antibiotic resistance to dissemination of ST1898 in the health care setting. This study highlights the additional benefits of whole-genome surveillance for colonizing pathogens, beyond routine species identification and genotyping, to inform targeted infection prevention strategies.
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RUIZ J, GARCÍA-ROBLES A, MARQUÉS MR, COMPANY MJ, SOLANA A, POVEDA JL. Influence of pharmacokinetic/pharmacodynamic ratio on vancomycin treatment response in pediatric patients with Staphylococcus aureus bacteremia. Minerva Pediatr (Torino) 2022; 74:525-529. [DOI: 10.23736/s2724-5276.18.04978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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8
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Dalabih A, Young HL, Frenner RA, Stroud MH, Boyanton BL. SARS-CoV-2 Prevention Measures Concomitantly Attenuate Methicillin-Resistant Staphylococcus aureus Infection Rates. Clin Pediatr (Phila) 2022; 61:137-140. [PMID: 35132903 DOI: 10.1177/00099228211067898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Abdallah Dalabih
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Heather L Young
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Michael H Stroud
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bobby L Boyanton
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Arkansas Children's Hospital, Little Rock, AR, USA
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Muhlebach MS, Jiang X, Kosorok MR, Klein EY, Saiman L. Longitudinal changes and regional variation of incident infection rates at cystic fibrosis centers, United States 2010-2016. J Cyst Fibros 2021; 21:34-39. [PMID: 34456157 DOI: 10.1016/j.jcf.2021.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/08/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiple factors affect incident infection rates (IIR) for Pseudomonas aeruginosa (PA) and methicillin resistant Staphylococcus aureus (MRSA) at CF care centers. We assessed changes in IIR across CF centers temporally associated with the 2013 Infection/Prevention & Control guidelines controlling for center-specific factors. METHODS Using the CF Foundation Patient Registry we defined and measured changes in IIR between 2010-2012 and 2014-2016. Data were compared to non-CF rates of MRSA and resistant PA in geographically similar regions. Characteristics of each CF center (n centers: Adult 54 in 2010 to 82 in 2016. Pediatric ∼106) and their respective population were evaluated for associations with IIR and with changes in IIR between the study periods. RESULTS Across the years 35613 patients were included. Incident-infection rates for PA (mean 19.2±0.04% Pediatric, 21.2±0.07% Adult centers) were higher than for MRSA (mean 9.4±0.03% Pediatric, 7.8±0.03% Adult). The IIR decreased for MRSA (-1.54±0.54%, p<0.001) and PA (-4.77±0.63%, p<0.001) at Pediatric but only for PA (-3.20±1.31, p=0.02) at Adult centers. Except for Adult CF, MRSA rates (CF and non-CF) were highest in the South. In 2014-2016, private insurance and a higher proportion of LatinX patients at a center were associated with lower MRSA IIR while larger center size, higher proportion of LatinX, and lower mean center-wide lung function were associated with higher PA IIR. Higher IIR in 2010-2012, were predictive of a more pronounced decrease in IIR in 2014-2016 for MRSA and PA (p<0.001). Different factors indicative of lower social status (smoking, insurance, education) in 2010-2012 predicted decreases in MRSA or PA IIR. CONCLUSION Comparisons of IIR across U.S. CF centers should consider location, ethnic background and socio-economic variables of a center's population.
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Affiliation(s)
- Marianne S Muhlebach
- Department of Pediatrics, Division Pulmonology CB#7217 University of North Carolina, Chapel Hill, NC 27599-7217, United States; Marsico Lung Institute, 130 Mason Farm Rd. CB #7020 UNC-CH Chapel Hill NC 27599-7020. United States.
| | - Xiaotong Jiang
- Department of Biostatistics, University of North Carolina, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC 27599-7400, United States
| | - Michael R Kosorok
- Department of Biostatistics, University of North Carolina, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC 27599-7400, United States
| | - Eili Y Klein
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, 622 W 168th St, New York, NY 10032, United States; Department of Infection Prevention & Control, NewYork-Presbyterian Hospital, New York, 622 W 168th St, New York, NY 10032, United States
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10
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Duguid RC, Al Reesi M, Bartlett AW, Palasanthiran P, McMullan BJ. Impact of Infectious Diseases Consultation on Management and Outcome of Staphylococcus aureus Bacteremia in Children. J Pediatric Infect Dis Soc 2021; 10:569-575. [PMID: 33355663 DOI: 10.1093/jpids/piaa155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND To examine the impact of infectious diseases consultation (IDC) on the management and outcome of Staphylococcus aureus bacteremia (SAB) in children. METHODS A retrospective cohort study of children with SAB at a teritary pediatric hospital (January 2009-June 2015) identified by medical record review as to whether they received an IDC for SAB at the discretion of the admitting physician or surgeon was conducted. Differences in management and outcomes for those with and without IDC were evaluated, and multivariate regression analysis was used to determine factors associated with cure. RESULTS There were 100 patients included in the analysis. Fifty-five patients received IDC and 45 had no IDC (NIDC). Appropriate directed therapy within 24 hours (54/55 = 98.2% vs 34/45 = 75.6%, P < .01), choice (54/55 = 98.2% vs 37/45 = 82.2%, P < .01), dose (54/55 = 98.2% vs 36/45 = 80%, P < .01), and duration (52/55 = 94.5% vs 24/45 = 53.3%, P < .01) of directed antibiotic therapy were appropriate in more IDC group patients. Achievement of source control in indicated cases was also more common in the IDC group (28/32 = 87.5% vs 5/26 = 19.1%, P < .01). Appropriate investigation with repeat blood cultures and echocardiograms was not significantly different. All 55 patients in the IDC group had a complete response (cure) compared with 40 of the 45 (88.9%) patients in the NIDC group: 2 patients died and 3 patients had a relapse of infection with subsequent cure. In multivariate regression analysis, methicillin-susceptible SAB and IDC were factors independently associated with cure. CONCLUSIONS Children who received IDC for SAB in a tertiary pediatric setting were more likely to have appropriate investigations and management and had improved outcomes.
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Affiliation(s)
- Robert C Duguid
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Mohammed Al Reesi
- Infectious Diseases Unit, Paediatric Department, Suhar Hospital, Suhar, Oman
| | - Adam W Bartlett
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Pamela Palasanthiran
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Brendan J McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,National Centre for Infections in Cancer, The University of Melbourne, Melbourne, Victoria, Australia
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11
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Lisowska-Łysiak K, Lauterbach R, Międzobrodzki J, Kosecka-Strojek M. Epidemiology and Pathogenesis of Staphylococcus Bloodstream Infections in Humans: a Review. Pol J Microbiol 2021; 70:13-23. [PMID: 33815523 PMCID: PMC8330453 DOI: 10.33073/pjm-2021-005] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/18/2021] [Accepted: 01/12/2021] [Indexed: 01/19/2023] Open
Abstract
Staphylococci are among the most frequent human microbiota components associated with the high level of bloodstream infection (BSI) episodes. In predisposed patients, there is a high risk of transformation of BSI episodes to sepsis. Both bacterial and host factors are crucial for the outcomes of BSI and sepsis. The highest rates of BSI episodes were reported in Africa, where these infections were up to twice as high as the European rates. However, there remains a great need to analyze African data for comprehensive quantification of staphylococcal BSI prevalence. The lowest rates of BSI exist in Australia. Asian, European, and North American data showed similar frequency values. Worldwide analysis indicated that both Staphylococcus aureus and coagulase-negative staphylococci (CoNS) are the most frequent BSI agents. In the second group, the most prevalent species was Staphylococcus epidermidis, although CoNS were not identified at the species level in many studies. The lack of a significant worldwide decrease in BSI episodes indicates a great need to implement standardized diagnostic methods and research etiological factors using advanced genetic methods.
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Affiliation(s)
- Klaudia Lisowska-Łysiak
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - Ryszard Lauterbach
- Department of Neonatology, Collegium Medicum, Jagiellonian University, Kraków, Poland
| | - Jacek Międzobrodzki
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - Maja Kosecka-Strojek
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
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12
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Arakawa S, Kasai M, Kawai S, Sakata H, Mayumi T. The JAID/JSC guidelines for management of infectious diseases 2017 - Sepsis and catheter-related bloodstream infection. J Infect Chemother 2021; 27:657-677. [PMID: 33558043 DOI: 10.1016/j.jiac.2019.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 10/28/2019] [Accepted: 11/29/2019] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Masashi Kasai
- Division of Infectious Disease, Department of Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Shin Kawai
- The Department of General Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroshi Sakata
- Department of Pediatrics, Asahikawa Kosei Hospital, Hokkaido, Japan
| | - Toshihiko Mayumi
- Department of Emergency and Critical Care Medicine,University of Occupational and Environmental Health, Fukuoka, Japan
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13
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Ogunkunle TO, Adedoyin TO, Ernest SK, Hassan-Hanga F, Imam A, Olaosebikan R, Obaro SK. A Prospective Cohort Study of the Clinical Predictors of Bacteremia in Under-Five Children With Acute Undifferentiated Fever Attending a Secondary Health Facility in Northwestern Nigeria. Front Pediatr 2021; 9:730082. [PMID: 35242726 PMCID: PMC8885983 DOI: 10.3389/fped.2021.730082] [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: 06/24/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children with acute febrile illness with no localizing signs often receive antibiotics empirically in most resource-poor settings. However, little is known about the burden of bacteremia in this category of patients, and an appraisal is thus warranted. This will guide clinical practice and promote rational antibiotics use. METHODS We prospectively followed up 140 under-five children who presented with acute undifferentiated fever at the emergency/outpatient pediatric unit of a secondary healthcare facility. Baseline clinical and laboratory information was obtained and documented in a structured questionnaire. We compared baseline characteristics between participants with bacteremia and those without bacteremia. We further fitted a multivariable logistic regression model to identify factors predictive of bacteremia among the cohort. RESULT The prevalence of bacteremia was 17.1%, and Salmonella Typhi was the most frequently (40.9%) isolated pathogen. The majority (78.6%) of the study participants were managed as outpatients. The participants who required admission were four times more likely to have bacteremia when compared to those managed as outpatients (AOR 4.08, 95% CI 1.19 to 14.00). There is a four times likelihood of bacteremia (AOR 4.75, 95% CI 1.48 to 15.29) with a fever duration of beyond 7 days. Similarly, participants who were admitted with lethargy were six times more likely to have bacteremia (AOR 6.20, 95% CI 1.15 to 33.44). Other significant predictors were tachypnea and lymphopenia. CONCLUSION Among under-five children with acute undifferentiated fever, longer duration of fever, lethargy, inpatient care, tachypnea, and lymphopenia were the significant predictors of bacteremia.
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Affiliation(s)
| | - Timothy Olanrewaju Adedoyin
- Department of Paediatrics and Child Health, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Samuel Kolade Ernest
- Department of Paediatrics and Child Health, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Fatimah Hassan-Hanga
- Department of Paediatrics and Child Health, Aminu Kano University Teaching Hospital, Kano, Nigeria
| | - Abdulazeez Imam
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rasaq Olaosebikan
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, United States
| | - Stephen K Obaro
- Division of Pediatric Infectious Diseases, Department of Pediatrics/Department of Microbiology and Pathology, University of Nebraska Medical Center, Omaha, NE, United States
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14
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Impact of rapid diagnostics with antimicrobial stewardship support for children with positive blood cultures: A quasi-experimental study with time trend analysis. Infect Control Hosp Epidemiol 2020; 41:883-890. [PMID: 32571440 DOI: 10.1017/ice.2020.191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Evaluate the clinical impact of the implementation of VERIGENE gram-positive blood culture testing (BC-GP) coupled with antimicrobial stewardship result notification for children with positive blood cultures. DESIGN Quasi-experimental study. SETTING Quaternary children's hospital. PATIENTS Hospitalized children aged 0-21 years with positive blood culture events 1 year before and 1 year after implementation of BC-GP testing. METHODS The primary outcome was time to optimal antibiotic therapy for positive blood cultures, defined as receiving definitive therapy without unnecessary antibiotics (pathogens) or no antibiotics (contaminants). Secondary outcomes were time to effective therapy, time to definitive therapy, and time to stopping vancomycin, length of stay, and 30-day mortality. Time-to-therapy outcomes before and after the intervention were compared using Cox regression models and interrupted time series analyses, adjusting for patient characteristics and trends over time. Gram-negative events were included as a nonequivalent dependent variable. RESULTS We included 264 preintervention events (191 gram-positive, 73 gram-negative) and 257 postintervention events (168 gram-positive, 89 gram-negative). The median age was 2.9 years (interquartile range, 0.3-10.1), and 418 pediatric patients (80.2%) had ≥1 complex chronic condition. For gram-positive isolates, implementation of BC-GP testing was associated with an immediate reduction in time to optimal therapy and time to stopping vancomycin for both analyses. BC-GP testing was associated with decreased time to definitive therapy in interrupted time series analysis but not Cox modeling. No such changes were observed for gram-negative isolates. No changes in time to effective therapy, length of stay, or mortality were associated with BC-GP. CONCLUSIONS The implementation of BC-GP testing coupled with antimicrobial stewardship result notification was associated with decreased time to optimal therapy and time to stopping vancomycin for hospitalized children with gram-positive blood culture isolates.
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15
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Maternal-Fetal Perinatal Transmission of Staphylococcal Infections: A Report of Two Neonates. Case Rep Pediatr 2020; 2020:8886049. [PMID: 32607269 PMCID: PMC7315269 DOI: 10.1155/2020/8886049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022] Open
Abstract
Staphylococcal infection in terms of fetus is rare and is associated with either maternal staphylococcal sepsis or colonization that leads to vertical transmission. Antenatal invasive procedures are a recognized risk factor. Most reported newborns with fetal-onset staphylococcal infections have had a worse outcome. We report the story of two newborns who had pustular-bullous skin lesions at birth and responded successfully to antistaphylococcal antibiotics. Both neonates made complete recovery. It is important to suspect clinically the staphylococcal infections when bullous skin lesions are present in the newborn.
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16
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Li Y, Li Q, Zhang G, Ma H, Wu Y, Yi Q, Jiang L, Wan J, Suo F, Luo Z. Time to positivity of blood culture is a risk factor for clinical outcomes in Staphylococcus aureus bacteremia children: a retrospective study. BMC Infect Dis 2019; 19:437. [PMID: 31101087 PMCID: PMC6525363 DOI: 10.1186/s12879-019-3993-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Staphylococcus aureus (S. aureus) is a common cause of bacteremia, which leads to significant morbidity and mortality. We investigated the relationship between time to positivity (TTP) and clinical outcomes in children with S.aureus bacteremia in the China. METHODS A retrospective study of Staphylococcus aureus bacteremia inpatient was performed in Children's Hospital of Chongqing Medical University in China between 29 January 2014 and 29 August 2017. TTP and clinical parameters were determined and analyzed. The receiver operating characteristic (ROC) curves were plotted for optimal cut-off selection, multivariate logistic regression tests were performed to evaluate the association between TTP and clinical outcomes. RESULTS Overall, 84 cases were enrolled. We stated that in-hospital mortality is significantly higher in the early TTP (≤17 h) than in the late TTP (> 17 h) group (57.14% vs 7.14%, P = 0.000). Septic shock occurred in 57.14% of patients with early TTP and in 18.57% of patients with late TTP (P = 0.002). Detailed multivariate and statistical analysis revealed that early TTP, need for vasoactive agent were independent risk factors of in-hospital mortality; early TTP, need for vasoactive agent and APACHE II score ≥ 15 were independent risk factors of septic shock incidence in S. aureus bacteremia children. CONCLUSIONS Overall, TTP of ≤17 h appeared to correlate with the worse outcomes for S. aureus bacteremia children. These results have important implications in the assessments and management of pediatric S. aureus bacteremia in a clinical setting. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Yuanyuan Li
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Qinyuan Li
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Guangli Zhang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, 401122, China
| | - Huan Ma
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Yi Wu
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Qian Yi
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Lili Jiang
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Jiao Wan
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Fengtao Suo
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, 401122, China.
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17
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Gordon O, Cohen MJ, Gross I, Amit S, Averbuch D, Engelhard D, Milstone AM, Moses AE. Staphylococcus aureus Bacteremia in Children: Antibiotic Resistance and Mortality. Pediatr Infect Dis J 2019; 38:459-463. [PMID: 30239476 DOI: 10.1097/inf.0000000000002202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Staphylococcus aureus (SA) is a major cause of bacteremia in children. Methicillin-resistant SA (MRSA) is considered a public health threat; however, the differences in the prognosis of children with methicillin-susceptible SA (MSSA) versus MRSA bacteremia are not well defined. METHODS Data from all SA bacteremia events in children (0-16 years) from 2002 to 2016 in a single Israeli tertiary center were collected. Positive cultures within 48 hours of hospitalization were considered community associated (CA). Those obtained afterward or from children hospitalized within the previous year were considered health-care associated (HA). RESULTS We recorded 427 events, 284 (66%) were HA, 64 (15%) were MRSA and 9 (2%) were CA-MRSA. There was no increase in MRSA during the study period. In-hospital, 30-day and 1-year mortality were 3% (12 cases), 3.5% (16 cases), and 12% (50 cases), respectively. A multivariable analysis controlling for demographics, admitting department and prior morbidity showed an increased 1-year mortality in children with HA bacteremia (hazard ratio [HR] 4.1; 95% confidence interval [CI]: 1.3-12) and prior chronic disease (HR 3.4; 95% CI 1.2 to 9.0). MRSA was not independently associated with increased one-year mortality compared with MSSA: HR (95% CI: 1.4 [0.6-3.1]). CONCLUSIONS Short-term pediatric mortality after SA bacteremia is low. HA-SA bacteremia has an increased long-term risk for mortality, particularly in children with chronic diseases. Our data suggest mortality was not increased for MRSA compared with MSSA bacteremia. The very low rate of CA-MRSA bacteremia justifies the current practice not to include glycopeptides in the empiric treatment of CA bacteremia in Israel.
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Affiliation(s)
- Oren Gordon
- From the Department of Clinical Microbiology and Infectious Diseases.,Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Matan J Cohen
- From the Department of Clinical Microbiology and Infectious Diseases.,Clalit Health Services, Jerusalem, Israel
| | - Itai Gross
- Department of Pediatric Emergency Medicine, Pediatric Emergency Medicine at the Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sharon Amit
- From the Department of Clinical Microbiology and Infectious Diseases
| | - Dina Averbuch
- From the Department of Clinical Microbiology and Infectious Diseases.,Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dan Engelhard
- From the Department of Clinical Microbiology and Infectious Diseases.,Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Aaron M Milstone
- Division of Infectious Disease, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Allon E Moses
- From the Department of Clinical Microbiology and Infectious Diseases
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18
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Hamdy RF, Dona D, Jacobs MB, Gerber JS. Risk Factors for Complications in Children with Staphylococcus aureus Bacteremia. J Pediatr 2019; 208:214-220.e2. [PMID: 30879729 DOI: 10.1016/j.jpeds.2018.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/26/2018] [Accepted: 12/04/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To determine risk factors for complications in children with Staphylococcus aureus (S aureus) bacteremia, including methicillin resistance. STUDY DESIGN Single center, retrospective cohort study of children ≤18 years of age hospitalized with S aureus bacteremia. We compared clinical characteristics and outcomes between those with methicillin-sensitive S aureus (MSSA) and methicillin-resistant S aureus (MRSA) bacteremia. Multivariate regression models identified risk factors associated with developing complications and with longer duration of bacteremia. RESULTS We identified 394 episodes of S aureus bacteremia, 279 (70.8%) with MSSA, and 115 (29.2%) with MRSA. Primary site of infection was catheter-related in 34%, musculoskeletal in 30%, skin/soft tissue in 10.2%, pneumonia in 6.4%, and endovascular in 6.6%. Eight children (2.0%) died within 30 days because of S aureus bacteremia, 15 (3.5%) had recurrence within 30 days, and 38 (9.6%) had complications including septic emboli or a metastatic focus of infection. Methicillin resistance was associated with development of a complication (aOR 3.31; 95% CI 1.60-6.85), and catheter-related infections were less likely to be associated with a complication (aOR 0.40; 95% CI 0.15-1.03). In a Poisson regression analysis on duration of bacteremia, methicillin resistance, musculoskeletal infection, endovascular infection, black race, and delayed intervention for source control were significantly associated with longer duration of bacteremia. CONCLUSIONS In this cohort of children with S aureus bacteremia, MRSA infections ere associated with longer duration of bacteremia and a higher likelihood of complications.
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Affiliation(s)
- Rana F Hamdy
- Department of Pediatrics, Children's National Health System, Washington, DC.
| | - Daniele Dona
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Marni B Jacobs
- Department of Biostatistics and Study Epidemiology, Children's National Health System, Washington, DC
| | - Jeffrey S Gerber
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
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19
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O'Reilly D, O'Connor C, McCallion N, Drew RJ. A retrospective study (2001-2017) of acute and chronic morbidity and mortality associated with Staphylococcus aureus bacteraemia in a tertiary neonatal intensive care unit. Ir J Med Sci 2019; 188:1297-1301. [PMID: 30805770 DOI: 10.1007/s11845-019-01992-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/16/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Staphylococcus aureus bacteraemia (SAB) in NICU patients can cause significant morbidity and mortality. AIMS To review early and late neonatal SAB with regard to risk factors, treatment, acute complications and long-term outcomes. METHODS A retrospective study of laboratory confirmed SAB over a 16-year period (November 2001-January 2017) in a tertiary neonatal unit in Ireland. FINDINGS A total of 74 neonates (MSSA n = 72, MRSA n = 2) were identified; 8.1% (n = 6) early sepsis, 91.8% (n = 68) late sepsis. Low birth weight neonates (born weighing less than 2500 g) 80% (n = 59). Median age to bacteraemia 11 days post-delivery (range = 0-100 days); median onset early sepsis 1.5 days versus late sepsis 12 days. Complications of SAB; cellulitis n = 17, pneumonia n = 12, necrotising enterocolitis n = 7, thromobophlebitis n = 5, skin abscess formation n = 4, osteomyelitis n = 3, endocarditis n = 1. Late SAB mortality 6.4% (n = 3). CONCLUSIONS Preterm and low birth weight infants were at highest risk of SAB. Only a small proportion of affected children had long-term clinical sequelae on follow-up. The high rate of recurrence and breakthrough bacteraemia suggests that early implementation of a targeted anti-staphylococcal antimicrobial regimen may be of particular benefit.
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Affiliation(s)
- Daniel O'Reilly
- Department of Neonatology, Rotunda Hospital, Dublin 1, Ireland.
| | - Ciara O'Connor
- Department of Clinical Microbiology, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - Naomi McCallion
- Department of Neonatology, Rotunda Hospital, Dublin 1, Ireland
- Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Richard J Drew
- Clinical Innovation Unit, Rotunda Hospital, Dublin 1, Ireland
- Department of Microbiology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Irish Meningitis and Sepsis Reference Laboratory (IMSRL), Temple Street Children's University Hospital, Dublin 1, Ireland
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20
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Oestergaard LB, Schmiegelow MDS, Bruun NE, Skov R, Andersen PS, Larsen AR, Gerds TA, Dahl A, Petersen A, Lauridsen TK, Nygaard U, Torp-Pedersen C. Staphylococcus aureus Bacteremia in Children Aged 5-18 Years-Risk Factors in the New Millennium. J Pediatr 2018; 203:108-115.e3. [PMID: 30244992 DOI: 10.1016/j.jpeds.2018.07.093] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/16/2018] [Accepted: 07/26/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the association between comorbidities and Staphylococcus aureus bacteremia in children aged 5-18 years, thus, in children with a matured immune system. Further, we aimed to identify presumably healthy children acquiring bacteremia. STUDY DESIGN By cross-linking nationwide registries, we consecutively included all children born from 1995 onward at their 5-year birthday or date of immigration during 2000-2015. We examined incidence rate ratios (IRR) between preselected exposures and microbiologically verified S aureus bacteremia (reference = children without exposure) using Poisson regression models. RESULTS We followed 1 109 169 children in 2000-2015 during which 307 children (incidence rate: 3.7 per 100 000 person-years) acquired S aureus bacteremia (methicillin-resistant S aureus = 8; 2.6%). Children without known comorbidities or recent contact with the healthcare system comprised 37.1% of infected children. The highest IRRs were observed in children undergoing dialysis or plasmapheresis (IRR = 367.2 [95% CI) = 188.5-715.3]), children with organ transplantation (IRR = 149.5 [95% CI = 73.9-302.2]), and children with cancer (IRR = 102.9 [95% CI = 74.4-142.2]). Positive associations also were observed in children with chromosomal anomalies (IRR = 7.16 [95% CI = 2.96-17.34]), atopic dermatitis (IRR = 4.89 [95% CI = 3.11-7.69]), congenital heart disease (IRR = 3.14 [95% CI = 1.92-5.11]), and in children undergoing surgery (IRR = 3.34 [95% CI = 2.59-4.28]). Neither premature birth nor parental socioeconomic status was associated with increased disease rates. CONCLUSIONS S aureus bacteremia is uncommon in children between 5 and 18 years of age. Risk factors known from the adult population, such as dialysis, plasmapheresis, organ transplantation, and cancer, were associated with the highest relative rates. However, prematurity and parental socioeconomic status were not associated with increased rates. Approximately one-third of infected children were presumably healthy.
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Affiliation(s)
- Louise Bruun Oestergaard
- The Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark; The Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark.
| | | | - Niels E Bruun
- Clinical Institute, Copenhagen University, Copenhagen, Denmark; The Department of Cardiology, Zealand University Hospital, Roskilde, Denmark; Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Robert Skov
- The Department of Microbiology and Infection Control, Statens Serum Institut (SSI), Copenhagen, Denmark
| | - Paal S Andersen
- The Department of Microbiology and Infection Control, Statens Serum Institut (SSI), Copenhagen, Denmark; Department of Animal and Veterinary Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anders R Larsen
- The Department of Microbiology and Infection Control, Statens Serum Institut (SSI), Copenhagen, Denmark
| | - Thomas A Gerds
- The Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Anders Dahl
- The Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Andreas Petersen
- The Department of Microbiology and Infection Control, Statens Serum Institut (SSI), Copenhagen, Denmark
| | - Trine K Lauridsen
- The Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Ulrikka Nygaard
- The Department of Pediatrics, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- The Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark; Clinical Institute, Aalborg University, Aalborg, Denmark
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21
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Munro APS, Blyth CC, Campbell AJ, Bowen AC. Infection characteristics and treatment of Staphylococcus aureus bacteraemia at a tertiary children's hospital. BMC Infect Dis 2018; 18:387. [PMID: 30097020 PMCID: PMC6086073 DOI: 10.1186/s12879-018-3312-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 08/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Staphylococcus aureus bacteraemia (SAB) causes considerable morbidity and mortality in children. Despite this, its epidemiology and risk factors are poorly understood, with minimal paediatric clinical trial data available to guide clinicians in management. We conducted a pilot study to characterise SAB and validate a severity classification for use in future clinical trials. METHODS Patients with SAB were prospectively identified at Princess Margaret Hospital for Children (Perth, Western Australia) from May 2011 to December 2013. Retrospective data were collected from clinical and laboratory records. Cases were classified based on a priori defined criteria as simple (single or contiguous, peripheral site focus) or complex (multi-site, deep tissue, no focus or sepsis) and tested against risk factors and markers of severity of infection. RESULTS There were 49 cases of SAB (median age 7.7 years), with classification as simple (n = 30, 61%) and complex (n = 19, 39%) respectively. There were no deaths or relapses in our cohort. Only 10% of isolates were methicillin resistant S. aureus (MRSA), and none of these were healthcare-associated. Age, gender, Indigenous status, MRSA and healthcare-associated infections were not predictive of complex infection. Pre-existing malignancy was a risk factor for complex infection (p = 0.02). Complex infections were associated with a higher median maximum C reactive protein (216 mg/L vs 50 mg/L, p = < 0.001), longer median length of stay (42 vs 10 days, p = < 0.001) and longer duration of antibiotic therapy (43 vs 34 days, p = 0.03). DISCUSSION This is the first attempt to categorise paediatric SAB as simple versus complex, to guide clinicians in decision making. CONCLUSIONS There is a wide spectrum of disease severity in paediatric SAB, with maximum CRP, length of stay, and duration of therapy greater in those with complex disease. Distinct cohorts with simple and complex courses which may be a target for future clinical trials have been described.
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Affiliation(s)
- Alasdair P. S. Munro
- Department of Infectious Diseases, Perth Children’s Hospital, Hospital Ave, Nedlands, WA 6009 Australia
- Royal Hampshire County Hospital, Romsey Road, Winchester, Hampshire SO22 5DG UK
| | - Christopher C. Blyth
- Department of Infectious Diseases, Perth Children’s Hospital, Hospital Ave, Nedlands, WA 6009 Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Roberts Road, Subiaco, WA 6008 Australia
- Department of Microbiology, PathWest Laboratory Medicine WA, Hospital Ave, Nedlands, WA 6009 Australia
- Centre for Child Health Research, School of Medicine, University of Western Australia, Nedlands, WA 6009 Australia
| | - Anita J. Campbell
- Department of Infectious Diseases, Perth Children’s Hospital, Hospital Ave, Nedlands, WA 6009 Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Roberts Road, Subiaco, WA 6008 Australia
- Centre for Child Health Research, School of Medicine, University of Western Australia, Nedlands, WA 6009 Australia
| | - Asha C. Bowen
- Department of Infectious Diseases, Perth Children’s Hospital, Hospital Ave, Nedlands, WA 6009 Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Roberts Road, Subiaco, WA 6008 Australia
- Centre for Child Health Research, School of Medicine, University of Western Australia, Nedlands, WA 6009 Australia
- Menzies School of Health Research, Charles Darwin University, Rocklands Drive, Tiwi, NT 0810 Australia
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22
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Doernberg SB, Lodise TP, Thaden JT, Munita JM, Cosgrove SE, Arias CA, Boucher HW, Corey GR, Lowy FD, Murray B, Miller LG, Holland TL. Gram-Positive Bacterial Infections: Research Priorities, Accomplishments, and Future Directions of the Antibacterial Resistance Leadership Group. Clin Infect Dis 2017; 64:S24-S29. [PMID: 28350900 DOI: 10.1093/cid/ciw828] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Antimicrobial resistance in gram-positive bacteria remains a challenge in infectious diseases. The mission of the Gram-Positive Committee of the Antibacterial Resistance Leadership Group (ARLG) is to advance knowledge in the prevention, management, and treatment of these challenging infections to improve patient outcomes. Our committee has prioritized projects involving methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) due to the scope of the medical threat posed by these pathogens. Approved ARLG projects involving gram-positive pathogens include (1) a pharmacokinetics/pharmacodynamics study to evaluate the impact of vancomycin dosing on patient outcome in MRSA bloodstream infection (BSI); (2) defining, testing, and validating innovative assessments of patient outcomes for clinical trials of MRSA-BSI; (3) testing new strategies for "step-down" antibiotic therapy for MRSA-BSI; (4) management of staphylococcal BSIs in neonatal intensive care units; and (5) defining the impact of VRE bacteremia and daptomycin susceptibility on patient outcomes. This article outlines accomplishments, priorities, and challenges for research of infections caused by gram-positive organisms.
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Affiliation(s)
- Sarah B Doernberg
- Division of Infectious Diseases, University of California, San Francisco
| | | | - Joshua T Thaden
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Jose M Munita
- Division of Infectious Diseases, University of Texas Health Sciences Center, Houston.,Clinica Alemana, Universidad del Desarrollo, Chile
| | - Sara E Cosgrove
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cesar A Arias
- Center for Antimicrobial Resistance and Microbial Genomics, Division of Infectious Diseases, University of Texas Health Sciences Center, Houston
| | - Helen W Boucher
- Division of Infectious Diseases, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - G Ralph Corey
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Franklin D Lowy
- Division of Infectious Diseases, Columbia University Medical Center, New York, New York
| | - Barbara Murray
- Division of Infectious Diseases, University of Texas Health Sciences Center, Houston
| | - Loren G Miller
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; and
| | - Thomas L Holland
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina.,Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
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Asgeirsson H, Thalme A, Weiland O. Staphylococcus aureus bacteraemia and endocarditis - epidemiology and outcome: a review. Infect Dis (Lond) 2017; 50:175-192. [PMID: 29105519 DOI: 10.1080/23744235.2017.1392039] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To review the epidemiology of Staphylococcus aureus bacteraemia (SAB) and endocarditis (SAE), and discuss the short- and long-term outcome. Materials and methods: A literature review of the epidemiology of SAB and SAE. RESULTS The reported incidence of SAB in Western countries is 16-41/100,000 person-years. Increasing incidence has been observed in many regions, in Iceland by 27% during 1995-2008. The increase is believed to depend on changes in population risk factors and possibly better and more frequent utilization of diagnostic procedures. S. aureus is now the leading causes of infective endocarditis (IE) in many regions of the world. It accounts for 15-40% of all IE cases, and the majority of cases in people who inject drugs (PWID). Recently, the incidence of SAE in PWID in Stockholm, Sweden, was found to be 2.5/1000 person-years, with an in-hospital mortality of 2.5% in PWID as compared to 15% in non-drug users. The 30-day mortality associated with SAB amounts to 15-25% among adults in Western countries, but is lower in children (0-9%). Mortality associated with SAE is high (generally 20-30% in-hospital mortality), and symptomatic cerebral embolizations are common (12-35%). The 1-year mortality reported after SAB and SAE is 19-62% and reflects deaths from underlying diseases and complications caused by the infection. In a subset of SAE cases, valvular heart surgery is needed (15-45%), but active intravenous drug use seems to be a reason to refrain from surgery. Despite its importance, there are insufficient data on the optimal management of SAB and SAE, especially on the required duration of antibiotic therapy. Conclusions: The epidemiology of SAB and SAE has been changing in the past decades. They still carry a substantial morbidity and mortality. Intensified studies on treatment are warranted for improving patient outcome.
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Affiliation(s)
- Hilmir Asgeirsson
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,b Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Anders Thalme
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Ola Weiland
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,b Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
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Corkum KS, Jones RE, Reuter CH, Kociolek LK, Morgan E, Lautz TB. Central venous catheter salvage in children with Staphylococcus aureus central line-associated bloodstream infection. Pediatr Surg Int 2017; 33:1201-1207. [PMID: 28948347 DOI: 10.1007/s00383-017-4165-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prompt central venous catheter (CVC) removal is currently recommended in children with Staphylococcus aureus central line-associated bloodstream infection (CLABSI). Our objective was to examine the outcome of attempted line salvage in children with S. aureus CLABSI and assess predictors of success. METHODS A single-institution, retrospective cohort study was performed of all children with S. aureus CLABSI between 2012 and 2015. Patients with and without immediate CVC removal (≤ 2 days after first positive culture) were compared. The primary outcome was failed CVC salvage (removal after 3+ days). RESULTS Seventy-seven children met criteria for S. aureus CLABSI. Immediate CVC removal was performed in 27.3% of patients. Among the 72.7% patients in whom CVC salvage was attempted, 78.6% were successful and 21.4% required delayed CVC removal. Malignancy, short gut syndrome, neutropenia, methicillin-resistant S. aureus, and line type were not associated with salvage failure. No associated morbidity or mortality occurred in patients with a failed salvage attempt. New or recurrent bacteremia occurred in five patients, but three were successfully salvaged a second time. CONCLUSIONS CVC salvage was feasible in the majority of children with S. aureus CLABSI and was not associated with significant complications or attributable mortality as reported in adults.
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Affiliation(s)
- Kristine S Corkum
- Feinberg School of Medicine, Northwestern University, Chicago, USA. .,Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.
| | - Rachel E Jones
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Caroline H Reuter
- Feinberg School of Medicine, Northwestern University, Chicago, USA.,Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Larry K Kociolek
- Feinberg School of Medicine, Northwestern University, Chicago, USA.,Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Elaine Morgan
- Feinberg School of Medicine, Northwestern University, Chicago, USA.,Division of Hematology and Oncology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Timothy B Lautz
- Feinberg School of Medicine, Northwestern University, Chicago, USA.,Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
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25
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Hamdy RF, Hsu AJ, Stockmann C, Olson JA, Bryan M, Hersh AL, Tamma PD, Gerber JS. Epidemiology of Methicillin-Resistant Staphylococcus aureus Bacteremia in Children. Pediatrics 2017; 139:peds.2017-0183. [PMID: 28562284 PMCID: PMC5470503 DOI: 10.1542/peds.2017-0183] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with high rates of treatment failure in adults. The epidemiology, clinical outcomes, and risk factors for treatment failure associated with MRSA bacteremia in children are poorly understood. METHODS Multicenter, retrospective cohort study of children ≤18 years hospitalized with MRSA bacteremia across 3 tertiary care children's hospitals from 2007 to 2014. Treatment failure was defined as persistent bacteremia >3 days, recurrence of bacteremia within 30 days, or attributable 30-day mortality. Potential risk factors for treatment failure, including the site of infection, vancomycin trough concentration, critical illness, and need for source control, were collected via manual chart review and evaluated using multivariable logistic regression. RESULTS Of 232 episodes of MRSA bacteremia, 72 (31%) experienced treatment failure and 23% developed complications, whereas 5 (2%) died within 30 days. Multivariable analysis of 174 children treated with vancomycin with steady-state vancomycin concentrations obtained found that catheter-related infections (odds ratio [OR], 0.36; 95% confidence interval [CI]: 0.13-0.94) and endovascular infections (OR, 4.35; 95% CI: 1.07-17.7) were associated with lower and higher odds of treatment failure, respectively, whereas a first vancomycin serum trough concentration <10 μg/mL was not associated with treatment failure (OR, 1.34; 95% CI, 0.49-3.66). Each additional day of bacteremia was associated with a 50% (95% CI: 26%-79%) increased odds of bacteremia-related complications. CONCLUSIONS Hospitalized children with MRSA bacteremia frequently suffered treatment failure and complications, but mortality was low. The odds of bacteremia-related complications increased with each additional day of bacteremia, emphasizing the importance of achieving rapid sterilization.
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Affiliation(s)
- Rana F. Hamdy
- Department of Pediatrics, Children’s National Health System, Washington, DC
| | - Alice J. Hsu
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Chris Stockmann
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Jared A. Olson
- Department of Pharmacy, Primary Children’s Hospital, Salt Lake City, Utah
| | - Matthew Bryan
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and
| | - Adam L. Hersh
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Pranita D. Tamma
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeffrey S. Gerber
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and
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26
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Kumarachandran G, Johnson JK, Shirley DA, Graffunder E, Heil EL. Predictors of Adverse Outcomes in Children With Staphylococcus aureus Bacteremia. J Pediatr Pharmacol Ther 2017. [PMID: 28638305 DOI: 10.5863/1551-6776-22.3.218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Staphylococcus aureus bacteremia is a common infection, associated with significant morbidity and mortality in children. Factors associated with adverse treatment outcomes are poorly understood in the pediatric population. METHODS Our study compared clinical and microbiologic characteristics of children admitted during a 5-year period (2007-2012) to a large university-based hospital and found to have S aureus bacteremia with outcome measures, in order to identify risk factors associated with treatment failure (defined as 30-day mortality, delayed microbiologic resolution, or recurrence of S aureus bacteremia within 60 days of completing effective antibiotic therapy). RESULTS In all, 71 patients were found to have S aureus bacteremia, and of these, 17 patients (24%) experienced treatment failure. Based on the logistic regression model, only high vancomycin minimum inhibitory concentration in combination with a high-risk source of infection (i.e., infected graft or device, intra-abdominal infection, or respiratory tract infection) was significantly associated with risk of treatment failure. CONCLUSIONS Infection associated with a high-risk source may increase the chance of treatment failure in pediatric patients with S aureus bacteremia. Vancomycin minimum inhibitory concentration alone was not found to be a predictor of treatment outcomes.
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27
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Morris AK, Russell CD. Enhanced surveillance of Staphylococcus aureus bacteraemia to identify targets for infection prevention. J Hosp Infect 2016; 93:169-74. [PMID: 27107617 DOI: 10.1016/j.jhin.2016.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Surveillance of Staphylococcus aureus bacteraemia (SAB) in Scotland is limited to the number of infections per 100,000 acute occupied bed-days and susceptibility to meticillin. AIM To demonstrate the value of enhanced SAB surveillance to identify targets for infection prevention. METHODS Prospective cohort study of all patients identified with SAB over a five-year period in a single health board in Scotland. All patients were reviewed at the bedside by a clinical microbiologist. FINDINGS In all, 556 SAB episodes were identified: 261 (46.6%) were hospital-acquired; 209 (37.9%) were healthcare-associated; 80 (14.4%) were community-acquired; and in six (1.1%) the origin of infection was not hospital-acquired, but could not be separated into healthcare-associated or community-acquired. These were classified as non-hospital-acquired. Meticillin-resistant S. aureus (MRSA) bacteraemia was associated with hospital-acquired and healthcare-associated infections. In addition, there was a significantly higher 30-day mortality associated with hospital-acquired (31.4%) and healthcare-associated (16.3%) infections compared to community-acquired SAB (8.7%). Vascular access devices were associated with hospital-acquired SAB and peripheral venous cannulas were the source for most of these (43.9%). Community-acquired infections were associated with intravenous drug misuse, respiratory tract infections and skeletal and joint infections. Skin and soft tissue infections were more widely seen in healthcare-associated infections. CONCLUSION The data indicate that enhanced surveillance of SAB by origin of infection and source of bacteraemia has implications for infection prevention, empirical antibiotic therapy, and health improvement interventions.
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Affiliation(s)
- A K Morris
- Department of Clinical Microbiology and Infection Control, Victoria Hospital, Kirkcaldy, Fife, UK.
| | - C D Russell
- School of Biomedical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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28
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Abstract
BACKGROUND Staphylococcus aureus is a major cause of bacteremia in children and is associated with high morbidity. Complete data are lacking on the incidence, related risk factors and mortality associated with this infection. METHODS Descriptive study including patients younger than 16 years admitted to a tertiary reference hospital, with blood cultures exclusively positive for S. aureus. Four study periods were established: period 1, 1995-1999; period 2, 2000-2002; period 3, 2006-2008 and period 4, 2010-2012. RESULTS In total, 269 episodes of S. aureus bacteremia (SAB) occurred in 242 patients. Over the total time studied, the incidence increased from 1.3 to 3.3 cases per 1000 patients hospitalized (relative risk: 2.71; 95% confidence interval: 1.85-3.95) and mortality decreased from 18% to 6% (P = 0.008). There were no differences in the resistance patterns of S. aureus strains. The prevalence of methicillin-resistant S. aureus (MRSA) increased from 3% to 13% between periods 1 and 2 and decreased from 14% to 3% between periods 3 and 4 (P = 0.011). The 30-day cumulative mortality was 3.3%, and the SAB-related mortality was 1.5%. Nosocomial acquisition and age 12-16 years were factors independently related with death on multivariate analysis. CONCLUSIONS The incidence of SAB tripled during the years studied but remained stable in the last period. Antimicrobial resistances did not increase. Although a decrease in mortality was documented, approximately half the 30-day cumulative mortality was caused by SAB.
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29
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Thaden JT, Ericson JE, Cross H, Bergin SP, Messina JA, Fowler VG, Benjamin DK, Clark RH, Hornik CP, Smith PB. Survival Benefit of Empirical Therapy for Staphylococcus aureus Bloodstream Infections in Infants. Pediatr Infect Dis J 2015; 34:1175-9. [PMID: 26222060 PMCID: PMC4604046 DOI: 10.1097/inf.0000000000000850] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The impact of early adequate empirical antibiotic therapy on outcomes of infants in the neonatal intensive care unit (NICU) who develop Staphylococcus aureus bloodstream infections (BSI) is unknown. METHODS Infants with S. aureus BSI discharged in 1997-2012 from 348 NICUs managed by the Pediatrix Medical Group were identified. Early adequate empirical antibiotic therapy was defined as exposure to ≥1 antibiotic with anti-staphylococcal activity on the day the first positive blood culture was obtained. All other cases were defined as inadequate empirical antibiotic therapy. We evaluated the association between inadequate empirical antibiotic therapy on outcomes controlling for gestational age, small for gestational age status, gender, discharge year, mechanical ventilation, inotropic support and use of supplemental oxygen. The primary outcome was 30-day mortality. Secondary outcomes were 7-day mortality, death before hospital discharge and length of bacteremia. RESULTS Of the 3339 infants with S. aureus BSI, 2492 (75%) had methicillin-susceptible S. aureus (MSSA) BSI and 847 (25%) had methicillin-resistant S. aureus (MRSA) BSI. Inadequate empirical antibiotic therapy was administered in 725 (22%) cases. Inadequate empirical antibiotic therapy was associated with increased 30-day mortality (odds ratio: 2.03; 95% confidence interval: 1.08-3.82) among infants with MRSA BSI. Inadequate empirical antibiotic therapy was not associated with increases in mortality among infants with MSSA BSI. CONCLUSIONS After controlling for confounders, inadequate empirical antibiotic therapy was associated with a modestly increased mortality at 30 days for infants with MRSA BSI.
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Affiliation(s)
- Joshua T. Thaden
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC
| | - Jessica E. Ericson
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Heather Cross
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Stephen P. Bergin
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Julia A. Messina
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Vance G. Fowler
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Daniel K. Benjamin
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Reese H. Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | - Christoph P. Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - P. Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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30
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Low mortality of Staphylococcus aureus bacteremia in Icelandic children: nationwide study on incidence and outcome. Pediatr Infect Dis J 2015; 34:140-4. [PMID: 24992124 DOI: 10.1097/inf.0000000000000485] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Staphylococcus aureus is a major cause of blood stream infections, but population-based studies on pediatric S. aureus bacteremia (SAB) are sparse. The objective of the study was to evaluate the incidence and mortality of SAB in Icelandic children over time, and to assess the proportions of nosocomial and health-care-associated infections. METHODS Children <18 years with positive blood cultures for S. aureus from January 1995 through December 2011 were identified retrospectively at the clinical microbiology laboratories performing blood cultures in Iceland. Clinical data were collected from medical records. RESULTS In total, 140 children had 146 distinct episodes of SAB. Bacteremia-related mortality was 0.7% (1/146), all-cause 30-day mortality, 1.4% (2/146), and 1-year mortality, 3.6% (5/140). The annual incidence of SAB was 10.9/100,000 children, decreasing by 36% from 13.1/100,000 in 1995-2003 to 8.4/100,000 in 2004-2011 (P < 0.001). At the same time the annual number of blood cultures analyzed at the main study site decreased from 1529 to 1143 (25%). SAB incidence was highest in infants (<1 year), 58.8/100,000. Of 146 episodes 50 (34%) were nosocomial, 21 (14%) health-care associated and 75 (51%) community acquired. No methicillin-resistant S. aureus isolate was identified. CONCLUSIONS In this nationwide study on pediatric SAB, the case fatality ratio was very low. A decreasing incidence was seen, possibly related to fewer blood cultures being collected. Nosocomial and health-care-associated infections accounted for 50% of the cases. The findings provide useful information on the epidemiology and outcome of SAB in children.
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Engelman D, Hofer A, Davis JS, Carapetis JR, Baird RW, Giffard PM, Holt DC, Tong SYC. Invasive Staphylococcus aureus Infections in Children in Tropical Northern Australia. J Pediatric Infect Dis Soc 2014; 3:304-11. [PMID: 26625450 DOI: 10.1093/jpids/piu013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 01/20/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Despite a high burden of staphylococcal skin disease in children and high incidence of Staphylococcus aureus bacteremia in adult Indigenous populations in northern Australia, there are few studies describing incidence or clinical information of invasive S aureus (ISA) infections in children. METHODS We conducted a retrospective review for all cases of S aureus bacteremia and sterile site infections, for children under 15 years, in northern Australia over a 4-year period (2007-2010). Cases were categorized as neonatal (<28 days) and pediatric (≥28 days). RESULTS Forty-four cases (9 neonatal, 35 pediatric) were identified. The annual incidence of ISA was 27.9 cases per 100 000 population. Among pediatric cases, the annual incidence was significantly higher in the Indigenous (46.6) compared with the non-Indigenous (4.4) population (IRR: 10.6 [95% confidence interval, 3.8-41.4]). Pediatric infections were predominantly community-associated (86%). Clinical infection sites included osteoarticular (66%), pleuropulmonary (29%), and endocarditis (9%), and multifocal disease was common (20%). Eighty-three percent of pediatric cases presented with sepsis; 34% resulted in intensive care admission. Neonatal cases were all born prematurely; 89% were late-onset infections. Overall, 27% of infections were due to methicillin-resistant S aureus (MRSA). Compared with methicillin-sensitive S aureus (MSSA), there was no difference in severity or presentation in pediatric MRSA cases, but a higher proportion of MRSA cases were readmitted. CONCLUSIONS The annual incidence of ISA infection in this study is among the highest described, largely due to a disproportionate burden in Indigenous children. Infections are frequently severe and infection with MRSA is common. Children presenting with suspected ISA in this region should be treated empirically for MRSA.
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Affiliation(s)
- Daniel Engelman
- Royal Darwin Hospital, Darwin, Australia; Centre for International Child Health, University of Melbourne, Australia
| | | | - Joshua S Davis
- Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia
| | - Jonathan R Carapetis
- Menzies School of Health Research, Darwin, Australia; Telethon Institute for Child Health Research, University of Western Australia, Perth
| | | | | | | | - Steven Y C Tong
- Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia
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Saunderson RB, Gouliouris T, Cartwright EJ, Nickerson EJ, Aliyu SH, O'Donnell DR, Kelsall W, Limmathurotsakul D, Peacock SJ, Török ME. Impact of infectious diseases consultation on the management of Staphylococcus aureus bacteraemia in children. BMJ Open 2014; 4:e004659. [PMID: 24989617 PMCID: PMC4091395 DOI: 10.1136/bmjopen-2013-004659] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Infectious diseases consultation (IDC) in adults with Staphylococcus aureus bacteraemia (SAB) has been shown to improve management and outcome. The aim of this study was to evaluate the impact of IDC on the management of SAB in children. STUDY DESIGN Observational cohort study of children with SAB. SETTING Cambridge University Hospitals National Health Service (NHS) Foundation Trust, a large acute NHS Trust in the UK. PARTICIPANTS All children with SAB admitted to the Cambridge University Hospitals NHS Foundation Trust between 16 July 2006 and 31 December 2012. METHODS Children with SAB between 2006 and 31 October 2009 were managed by routine clinical care (pre-IDC group) and data were collected retrospectively by case notes review. An IDC service for SAB was introduced in November 2009. All children with SAB were reviewed regularly and data were collected prospectively (IDC group) until 31 December 2012. Baseline characteristics, quality metrics and outcome were compared between the pre-IDC group and IDC group. RESULTS There were 66 episodes of SAB in 63 children-28 patients (30 episodes) in the pre-IDC group, and 35 patients (36 episodes) in the IDC group. The median age was 3.4 years (IQR 0.2-10.7 years). Patients in the IDC group were more likely to have echocardiography performed, a removable focus of infection identified and to receive a longer course of intravenous antimicrobial therapy. There were no differences in total duration of antibiotic therapy, duration of hospital admission or outcome at 30 or 90 days following onset of SAB. CONCLUSIONS IDC resulted in improvements in the investigation and management of SAB in children.
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Affiliation(s)
| | - Theodore Gouliouris
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Public Health England, Clinical Microbiology and Public Health Laboratory, Cambridge, UK
| | - Edward J Cartwright
- Department of Medicine, University of Cambridge, Cambridge, UK
- Public Health England, Clinical Microbiology and Public Health Laboratory, Cambridge, UK
| | - Emma J Nickerson
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sani H Aliyu
- Department of Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D Roddy O'Donnell
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Wilf Kelsall
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Sharon J Peacock
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Public Health England, Clinical Microbiology and Public Health Laboratory, Cambridge, UK
- Wellcome Trust Sanger Institute, Hinxton, UK
| | - M Estée Török
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Public Health England, Clinical Microbiology and Public Health Laboratory, Cambridge, UK
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Trends of Staphylococcus aureus bloodstream infections in a neonatal intensive care unit from 2000-2009. BMC Pediatr 2014; 14:121. [PMID: 24886471 PMCID: PMC4024190 DOI: 10.1186/1471-2431-14-121] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Invasive methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) infections are major causes of numerous neonatal intensive care unit (NICU) outbreaks. There have been increasing reports of MRSA outbreaks in various neonatal intensive care units (NICUs) over the last decade. Our objective was to review the experience of Staphylococcus aureus sepsis in our NICU in the last decade and describe the trends in the incidence of Staphylococcus aureus blood stream infections from 2000 to 2009. METHODS A retrospective perinatal database review of all neonates admitted to our NICU with blood cultures positive for Staphylococcus aureus from (Jan 1st 2000 to December 31st 2009) was conducted. Infants were identified from the database and data were collected regarding their clinical characteristics and co-morbidities, including shock with sepsis and mortality. Period A represents patients admitted in 2000-2003. Period B represents patients seen in 2004-2009. RESULTS During the study period, 156/11111 infants were identified with Staphylococcus aureus blood stream infection: 41/4486 (0.91%) infants in Period A and 115/6625 (1.73%) in Period B (p < 0.0004). Mean gestation at birth was 26 weeks for infants in both periods. There were more MRSA infections in Period B (24% vs. 55% p < 0.05) and they were associated with more severe outcomes. In comparing the cases of MRSA infections observed in the two periods, infants in period B notably had significantly more pneumonia cases (2.4% vs. 27%, p = 0.0005) and a significantly higher mortality rate (0% vs. 15.7%, p = 0.0038). The incidences of skin and soft tissue infections and of necrotizing enterocolitis were not significantly changed in the two periods. CONCLUSION There was an increase in the incidence of Staphylococcus aureus infection among neonates after 2004. Although MSSA continues to be a problem in the NICU, MRSA infections were more prevalent in the past 6 years in our NICU. Increased severity of staphylococcal infections and associated rising mortality are possibly related to the increasing MRSA infections with a more virulent community-associated strain.
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Abstract
Staphylococcus aureus bacteremia without a localizing source in children is not well described. We identified patients with a positive blood culture for S. aureus from an 11-year surveillance study. Thirty-six cases of primary bacteremia were identified accounting for 5.7% of bacteremias. Most patients had comorbidities (86.1%), most commonly immunosuppression (33.3%).
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Randolph AG, McCulloh RJ. Pediatric sepsis: important considerations for diagnosing and managing severe infections in infants, children, and adolescents. Virulence 2013; 5:179-89. [PMID: 24225404 PMCID: PMC3916372 DOI: 10.4161/viru.27045] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Sepsis is the leading cause of death in children worldwide. Although the diagnosis and management of sepsis in infants and children is largely influenced by studies done in adults, there are important considerations relevant for pediatrics. This article highlights pediatric-specific issues related to the definition of sepsis and its epidemiology and management. We review how the capacity of the immune system to respond to infection develops over early life. We also bring attention to primary immune deficiencies that should be considered in children recurrently infected with specific types of organisms. The management of pediatric sepsis must be tailored to the child’s age and immune capacity, and to the site, severity, and source of the infection. It is important for clinicians to be aware of infection-related syndromes that primarily affect children. Although children in developed countries are more likely to survive severe infections than adults, many survivors have chronic health impairments.
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Affiliation(s)
- Adrienne G Randolph
- Harvard Medical School; Boston, MA USA; Department of Anesthesia, Perioperative and Pain Medicine; Boston Children's Hospital; Boston, MA USA
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Naidoo R, Nuttall J, Whitelaw A, Eley B. Epidemiology of Staphylococcus aureus bacteraemia at a tertiary children's hospital in Cape Town, South Africa. PLoS One 2013; 8:e78396. [PMID: 24167621 PMCID: PMC3805599 DOI: 10.1371/journal.pone.0078396] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/11/2013] [Indexed: 11/18/2022] Open
Abstract
Background Staphylococcus aureus is an important pathogen in paediatric patients with bloodstream infections. The epidemiology of S. aureus bacteraemia, however, has not been well documented in children in South Africa. Methods A retrospective study was conducted at a children’s hospital in Cape Town, South Africa, to investigate the epidemiology of S. aureus bacteraemia from 2007-2011. The incidence, clinical presentation, risk factors, management and outcomes of methicillin sensitive S. aureus (MSSA) and methicillin resistant S. aureus (MRSA) bacteraemia were compared. Results Over the five year study period, 365 episodes of S. aureus bacteraemia were identified. The annual incidence was 3.28 cases per 1000 hospital admissions. MRSA was responsible for 26% of S. aureus bacteraemia and 72% of nosocomial infections. Only six possible cases of community-acquired MRSA infections were described. MSSA bacteraemia was more likely to present as pulmonary and bone or joint infections, while bacteraemia without a source was the most common presentation with MRSA. Infants, children with malnutrition, and residents of long-term care facilities were at highest risk for MRSA bacteraemia. The overall case fatality rate for S. aureus bacteraemia was 8.8% over five years, with MRSA being the only significant risk factor for mortality. Conclusion The incidence of S. aureus bacteraemia and MRSA bacteraemia in children has remained stable over the past five years. MRSA is a predominantly nosocomial pathogen in children with S. aureus bacteraemia in Cape Town, South Africa.
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Affiliation(s)
- Reené Naidoo
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital and the School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital and the School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Whitelaw
- National Health Laboratory Services, University of Cape Town, Cape Town, South Africa
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital and the School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Fielding-Singh V, Hong DK, Harris SJ, Hamilton JR, Schroeder AR. Ruling out bacteremia and bacterial meningitis in infants less than one month of age: is 48 hours of hospitalization necessary? Hosp Pediatr 2013; 3:355-361. [PMID: 24435193 DOI: 10.1542/hpeds.2013-0009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The appropriate duration of hospitalization for infants ≤ 30 days admitted for fever or other concerns for a serious bacterial infection is an understudied area. We sought to determine the risk of a positive, pathogenic bacterial culture of blood or cerebrospinal fluid (CSF) in this population beyond 24 hours after collection. METHODS This study was a retrospective review of 1145 infants aged ≤30 days who had a blood or CSF culture from 1999 to 2010 at Santa Clara Valley Medical Center, a county health system in San Jose, California. Time to notification and the probability of a positive culture result after 24 hours were calculated. Infants were considered high risk if they had either a white blood cell count <5000 or >15 000 per µL, a band count >1500 per µL, or an abnormal urinalysis. RESULTS We identified 1876 cultures (1244 blood, 632 CSF) in 1145 infants aged ≤30 days; 901 (79%) of 1145 were hospitalized and 408 (45%) of 901 hospitalizations were for fever without source (FWS). Thirty-one (2.7%) of the 1145 infants had pathogenic cultures; 6 of 1145 infants (0.5% [95% confidence interval: 0.2-1.1]) had a time to notification >24 hours. All 6 patients had FWS (1.5% of hospitalized FWS sample) and met high-risk criteria on presentation. No low-risk patients had a time to notification >24 hours. Low-risk characteristics were found in 57% (232 of 408) of the entire hospitalized FWS population. CONCLUSIONS Low-risk infants hospitalized for FWS or other concerns for serious bacterial infection may not need hospitalization for a full 48 hours simply to rule out bacteremia and bacterial meningitis.
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Park DA, Lee SM, Peck KR, Joo EJ, Oh EG. Impact of Methicillin-Resistance on Mortality in Children and Neonates with Staphylococcus aureus Bacteremia: A Meta-analysis. Infect Chemother 2013; 45:202-10. [PMID: 24265968 PMCID: PMC3780954 DOI: 10.3947/ic.2013.45.2.202] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 12/08/2012] [Accepted: 12/10/2012] [Indexed: 11/26/2022] Open
Abstract
Background Staphylococcus aureus bacteremia (SAB) is the Staphylococcal infections in blood, one of the most common and fatal bacterial infectious diseases worldwide in adults as well as children or neonates. Recently, some studies have yielded inconsistent findings about the association between methicillin-resistance and mortality in patients with SAB. We performed a meta-analysis to assess the impact of methicillin-resistance on mortality in children or neonates with S. aureus bacteremia. Materials and Methods We searched using electronic databases such as Ovid-Medline, EMBASE-Medline, and Cochrane Library, as well as five local databases for published studies during the period of 1 January 2000 to 15 September 2011. Two reviewers independently selected articles in accordance with predetermined criteria and extracted prespecified data based on standardized forms. All cohort studies, which compared in-hospital mortality or SAB-related mortality in children and neonates with methicillin-resistant S. aureus (MRSA) infection to those with methicillin-susceptible S. aureus (MSSA), were included. We conducted meta-analysis using the fixed-effect model to obtain pooled estimates of effect. Results Of 2,841 screened studies, seven cohort studies were finally selected for analysis. In children or neonates, MRSA bacteremia was associated with a higher mortality compared with MSSA bacteremia (pooled odds ratio [OR] 2.33, P = 0.0008, 95% confidence interval [CI] 1.42 to 3.82, I2 = 0%). Four studies reported SAB-related mortality, the pooled OR of these studies was 2.03 (P = 0.29, 95% CI 0.55 to 7.53, I2 = 0%). A significant increase in mortality associated with methicillin resistance was found in the subgroup analyses of the studies with only neonates (OR: 2.66, 95% CI: 1.46 to 4.85, P = 0.001), prospectively design ones (OR: 3.20, 95% CI: 1.66 to 6.15, P = 0.0005,), the larger studies (OR: 2.89, 95% CI: 1.62 to 5.16, P = 0.0003) and the higher quality studies (OR: 2.76, 95% CI: 1.50 to 5.06, P = 0.001). Conclusions MRSA bacteremia is associated with increased mortality compared with MSSA bacteremia in children or neonates. Due to limited studies for mortality in children or neonates with SAB, further research is needed to evaluate the impact of methicillin resistance on mortality in those populations.
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Affiliation(s)
- Dong Ah Park
- Office of Health Technology Evaluation, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea. ; College of Nursing Yonsei University, Seoul, Korea
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Gutierrez K, Halpern MS, Sarnquist C, Soni S, Arroyo AC, Maldonado Y. Staphylococcal infections in children, California, USA, 1985-2009. Emerg Infect Dis 2013; 19:10-20; quiz 185. [PMID: 23260060 PMCID: PMC3557972 DOI: 10.3201/eid1901.111740] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Young children, Black children, and those without private insurance were at higher risk for hospitalization.
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Affiliation(s)
- Kathleen Gutierrez
- Stanford University School of Medicine-Pediatrics, Stanford, California 94305, USA.
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van Hal SJ, Jensen SO, Vaska VL, Espedido BA, Paterson DL, Gosbell IB. Predictors of mortality in Staphylococcus aureus Bacteremia. Clin Microbiol Rev 2012; 25:362-86. [PMID: 22491776 PMCID: PMC3346297 DOI: 10.1128/cmr.05022-11] [Citation(s) in RCA: 636] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Staphylococcus aureus bacteremia (SAB) is an important infection with an incidence rate ranging from 20 to 50 cases/100,000 population per year. Between 10% and 30% of these patients will die from SAB. Comparatively, this accounts for a greater number of deaths than for AIDS, tuberculosis, and viral hepatitis combined. Multiple factors influence outcomes for SAB patients. The most consistent predictor of mortality is age, with older patients being twice as likely to die. Except for the presence of comorbidities, the impacts of other host factors, including gender, ethnicity, socioeconomic status, and immune status, are unclear. Pathogen-host interactions, especially the presence of shock and the source of SAB, are strong predictors of outcomes. Although antibiotic resistance may be associated with increased mortality, questions remain as to whether this reflects pathogen-specific factors or poorer responses to antibiotic therapy, namely, vancomycin. Optimal management relies on starting appropriate antibiotics in a timely fashion, resulting in improved outcomes for certain patient subgroups. The roles of surgery and infectious disease consultations require further study. Although the rate of mortality from SAB is declining, it remains high. Future international collaborative studies are required to tease out the relative contributions of various factors to mortality, which would enable the optimization of SAB management and patient outcomes.
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Affiliation(s)
- Sebastian J van Hal
- Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service—Liverpool, South Western Sydney Local Health Network, Sydney, New South Wales, Australia.
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Frymoyer A, Guglielmo BJ, Wilson SD, Scarpace SB, Benet LZ, Hersh AL. Impact of a hospitalwide increase in empiric pediatric vancomycin dosing on initial trough concentrations. Pharmacotherapy 2012; 31:871-6. [PMID: 21923588 DOI: 10.1592/phco.31.9.871] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVE To evaluate the impact of a hospitalwide increase in the recommended vancomycin starting dose from 45 to 60 mg/kg/day on initial vancomycin trough concentrations in children suspected of having an invasive methicillin-resistant Staphylococcus aureus (MRSA) infection. DESIGN Retrospective medical record review. SETTING Dedicated children's hospital located in a tertiary care, academic medical center. PATIENTS A total of 182 children aged 1 month-12 years with normal renal function who had suspected MRSA infections treated with vancomycin during two different starting dose recommendation periods: 45 mg/kg/day divided every 8 hours during July 2006-June 2007 (low-dose group [88 children]) and 60 mg/kg/day divided every 6 hours during July 2008-June 2009 (high-dose group [94 children]). MEASUREMENT AND MAIN RESULTS Data on patient demographics, vancomycin doses, and initial vancomycin trough concentrations were collected. No significant demographic differences were noted between patients in the low-dose and high-dose groups. The mean ± SD initial vancomycin trough level increased from 7 ± 5 μg/ml in the low-dose group to 9 ± 5 μg/ml in the high-dose group (p<0.001). The percentage of patients with an initial trough level less than 5 μg/ml declined from 38% (33/88 children) in the low-dose group to 17% (16/94 children) in the high-dose group (p<0.001), whereas the percentage of patients with an initial trough concentration in the potentially adverse range (> 20 μg/ml) did not change between the two groups (2% vs 2%, p=0.9). Less than 14% (13/94 children) achieved a trough level in the range of 15-20 μg/ml in the high-dose group. CONCLUSION An increase in the recommended vancomycin starting dose to 60 mg/kg/day decreased the likelihood of an initial low vancomycin trough level (< 5 μg/ml), with no increase in the proportion of patients with trough levels in a potentially toxic range. The 60-mg/kg/day dose did not consistently achieve a vancomycin trough of 15-20 μg/ml, a goal suggested by some experts for adults. Comparative effectiveness studies are needed to directly evaluate vancomycin dosing regimens and clinical outcomes for children with invasive MRSA infections.
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Affiliation(s)
- Adam Frymoyer
- Division of Clinical Pharmacology, Department of Medicine, University of California-San Francisco, San Francisco, California 94143-0503, USA.
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Staphylococcus aureus pneumonia in children in the era of community-acquired methicillin-resistance at Texas Children's Hospital. Pediatr Infect Dis J 2011; 30:545-50. [PMID: 21407143 DOI: 10.1097/inf.0b013e31821618be] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Community-acquired Staphylococcus aureus (SA) pneumonia has increased in children, yet few studies have focused on this infection. METHODS Patients with SA pneumonia (not ventilator-associated) were identified from our surveillance database. Medical records were reviewed; isolates were genotyped by PFGE and Panton-Valentine leukocidin genes detected by polymerase chain reaction. RESULTS From August 2001 to April 2009, 117 patients had SA pneumonia. The rate of SA pneumonia per 10,000 admissions increased from 4.81 hospitalizations in year 1 to 9.75 in year 7 (P = 0.04). Methicillin-resistant SA (MRSA) caused 74% and methicillin-susceptible SA (MSSA) caused 26% of the infections. USA300 represented 75/82 (92%) of the MRSA and 14/28 (50%) of the MSSA isolates (P < 0.01). Patients with MRSA were younger (median [range], 0.8 years [0.1-16.9 years]) than patients with MSSA infections (2.5 years [0.2-20.9 years]) (P = 0.008). Clinical presentation was pneumonia with or without effusion in 30, empyema in 72, or lung abscess in 15 cases. Viral coinfections in 18/68 patients tested were associated with respiratory failure (72% vs. 24% [P < 0.001]). Thirty-five children were intubated and 68 had intensive care unit care; 89, 25, and 3 had video-assisted thoracoscopy (VATS), thoracentesis, and lobectomy, respectively. VATS was used more for USA300 than non-USA300 infections (80% vs. 57% [P = 0.03]). In all, 88 children received clindamycin. Improvement or cure occurred in 103 patients (88%), unscheduled visit or readmission related to the same problem in 6, respiratory sequelae in 7, and death in 1 patient. CONCLUSIONS SA pneumonia increased in frequency over the study years and most were caused by community-acquired MRSA and USA300 isolates. Viral coinfection in 15% of the cases was associated with respiratory failure. Clindamycin is an effective treatment for susceptible-SA pneumonia; VATS was more common in patients with USA300 infections.
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Mitchell B, Gardner A, Collignon P, Stewart L, Cruickshank M. A literature review supporting the proposed national Australian definition for Staphylococcus aureus bacteraemia. ACTA ACUST UNITED AC 2010. [DOI: 10.1071/hi10030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Putnam SD, Sader HS, Moet GJ, Mendes RE, Jones RN. Worldwide summary of telavancin spectrum and potency against Gram-positive pathogens: 2007 to 2008 surveillance results. Diagn Microbiol Infect Dis 2010; 67:359-68. [DOI: 10.1016/j.diagmicrobio.2010.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 03/18/2010] [Indexed: 11/28/2022]
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Management of Staphylococcus aureus bacteremia and endocarditis: progresses and challenges. Curr Opin Infect Dis 2010; 23:346-58. [DOI: 10.1097/qco.0b013e32833bcc8a] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Frymoyer A, Hersh AL, Coralic Z, Benet LZ, Joseph Guglielmo B. Prediction of vancomycin pharmacodynamics in children with invasive methicillin-resistant Staphylococcus aureus infections: a Monte Carlo simulation. Clin Ther 2010; 32:534-42. [PMID: 20399990 DOI: 10.1016/j.clinthera.2010.03.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Due to the emergence of community-associated strains, the prevalence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections has increased substantially in pediatric patients. A vancomycin AUC(0-24)/MIC index >400 best predicts treatment outcomes for invasive MRSA infection in adults. Data on whether recommended vancomycin doses in children achieve this break point are lacking. OBJECTIVE This study aimed to assess the likelihood that currently recommended vancomycin doses in children achieve AUC(0-24)/MIC >400. METHODS Vancomycin AUC(0-24)/MIC predictions were conducted across a range of dosages (40-70 mg/kg/d) using a Monte Carlo simulation (n = 5000). AUC(0-24) was calculated as daily dose divided by vancomycin clearance, and daily dose was fixed for a given simulation. Three literature-reported estimates in children were used to define vancomycin clearance and its variance. For the MIC distribution of MRSA isolates, susceptibility data were obtained from the University of California, San Francisco Children's Hospital, San Francisco, California (n = 180; 40% < or =0.5 mg/L; 59% = 1 mg/L; and 1% = 2 mg/L). RESULTS Using the recommended empiric dosage of 40 mg/kg/d, 58% to 66% of children were predicted to achieve AUC(0-24)/MIC >400. Increasing the vancomycin dosage to 60 mg/kg/d substantially increased the likelihood (88%-98%) of achieving this pharmacodynamic target. On sensitivity analysis, a dosage of 40 mg/kg/d was more strongly influenced by small changes in MIC compared with 60 mg/kg/d. CONCLUSIONS Recommended empiric vancomycin dosing in children (40 mg/kg/d) was not predicted to consistently achieve the pharmacodynamic target of AUC(0-24)/MIC >400 for invasive MRSA infections. A vancomycin dosage of 60 mg/kg/d was predicted to optimize achievement of this target in children.
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Affiliation(s)
- Adam Frymoyer
- Division of Clinical Pharmacology, Department of Medicine, University of California, San Francisco, California 94143-0912, USA.
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Higher prevalence of pharyngeal than nasal Staphylococcus aureus carriage in pediatric intensive care units. J Clin Microbiol 2010; 48:2957-9. [PMID: 20573867 DOI: 10.1128/jcm.00547-10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sensitive detection of Staphylococcus aureus colonization is important for epidemiologic studies, infection control, and decolonization measures. We examined the sensitivity of nasal and pharyngeal sampling for S. aureus colonization in 331 children admitted to intensive care units. Pharyngeal screening was more sensitive than nasal screening (92.6% versus 63.1%, P < 0.0001).
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Herigon JC, Hersh AL, Gerber JS, Zaoutis TE, Newland JG. Antibiotic management of Staphylococcus aureus infections in US children's hospitals, 1999-2008. Pediatrics 2010; 125:e1294-300. [PMID: 20478934 DOI: 10.1542/peds.2009-2867] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The objective of this study was to describe trends in antibiotic management for Staphylococcus aureus infections among hospitalized children from 1999 to 2008. METHODS A retrospective study was conducted by using the Pediatric Health Information Systems database to describe antibiotic treatment of inpatients with S aureus infection at 25 children's hospitals in the United States. Patients who were admitted from 1999 to 2008 with International Classification of Diseases, Ninth Revision, Clinical Modification codes for S aureus infection were included. Trends in the use of vancomycin, clindamycin, linezolid, trimethoprim-sulfamethoxazole, cefazolin, and oxacillin/nafcillin were examined for percentage use and days of therapy per 1000 patient-days. RESULTS A total of 64813 patients had a discharge diagnosis for S aureus infection. The incidence of methicillin-resistant S aureus (MRSA) infections during this period increased 10-fold, from 2 to 21 cases per 1000 admissions, whereas the methicillin-susceptible S aureus infection rate remained stable. Among patients with S aureus infections, antibiotics that treat MRSA increased from 52% to 79% of cases, whereas those that treat only methicillin-susceptible S aureus declined from 66% to <30% of cases. Clindamycin showed the greatest increase, from 21% in 1999 to 63% in 2008. Similar trends were observed by using days of therapy per 1000 patient-days. CONCLUSIONS Antibiotic prescribing patterns for the treatment of S aureus infections have changed significantly during the past decade, reflecting the emergence of community-associated MRSA. Clindamycin is now the most commonly prescribed antibiotic for S aureus infections among hospitalized children. The substantial use of clindamycin emphasizes the importance of continuous monitoring of local S aureus susceptibility patterns.
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Affiliation(s)
- Joshua C Herigon
- Children's Mercy Hospital and Clinics, Section of Infectious Diseases, 2401 Gillham Rd, Kansas City, MO 64108, USA
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