TY - JOUR
T1 - Pediatric Staphylococcus aureus Bacteremia
T2 - Clinical Spectrum and Predictors of Poor Outcome
AU - Campbell, Anita J
AU - Al Yazidi, Laila S
AU - Phuong, Linny K
AU - Leung, Clare
AU - Best, Emma J
AU - Webb, Rachel H
AU - Voss, Lesley
AU - Athan, Eugene
AU - Britton, Philip N
AU - Bryant, Penelope A
AU - Butters, Coen T
AU - Carapetis, Jonathan R
AU - Ching, Natasha S
AU - Coombs, Geoffrey W
AU - Daley, Denise A
AU - Francis, Joshua R
AU - Hung, Te-Yu
AU - Mowlaboccus, Shakeel
AU - Nourse, Clare
AU - Ojaimi, Samar
AU - Tai, Alex
AU - Vasilunas, Nan
AU - McMullan, Brendan
AU - Blyth, Christopher C
AU - Bowen, Asha C
N1 - © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2022/2/15
Y1 - 2022/2/15
N2 - Staphylococcus aureus is a common cause of bacteremia, yet the epidemiology and predictors of poor outcome remain inadequately defined in childhood. Methods: ISAIAH (Invasive Staphylococcus aureus Infections and Hospitalizations in children) is a prospective, cross-sectional study of S. aureus bacteremia (SAB) in children hospitalized in Australia and New Zealand over 24 months (2017-2018). Results: Overall, 552 SABs were identified (incidence 4.4/100 000/year). Indigenous children, those from lower socioeconomic areas and neonates were overrepresented. Although 90-day mortality was infrequent, one-third experienced the composite of: length of stay >30 days (26%), intensive care unit admission (20%), relapse (4%), or death (3%). Predictors of mortality included prematurity (adjusted odds ratio [aOR],16.8; 95% confidence interval [CI], 1.6-296.9), multifocal infection (aOR, 22.6; CI, 1.4-498.5), necrotizing pneumonia (aOR, 38.9; CI, 1.7-1754.6), multiorgan dysfunction (aOR, 26.5; CI, 4.1-268.8), and empiric vancomycin (aOR, 15.7; CI, 1.6-434.4); while infectious diseases (ID) consultation (aOR, 0.07; CI. 004-.9) was protective. Neither MRSA nor vancomycin trough targets impacted survival; however, empiric vancomycin was associated with nephrotoxicity (OR, 3.1; 95% CI 1.3-8.1). Conclusions: High SAB incidence was demonstrated and for the first time in a pediatric setting, necrotizing pneumonia and multifocal infection were predictors of mortality, while ID consultation was protective. The need to reevaluate pediatric vancomycin trough targets and limit unnecessary empiric vancomycin exposure to reduce poor outcomes and nephrotoxicity is highlighted. One in 3 children experienced considerable SAB morbidity; therefore, pediatric inclusion in future SAB comparator trials is paramount to improve outcomes.
AB - Staphylococcus aureus is a common cause of bacteremia, yet the epidemiology and predictors of poor outcome remain inadequately defined in childhood. Methods: ISAIAH (Invasive Staphylococcus aureus Infections and Hospitalizations in children) is a prospective, cross-sectional study of S. aureus bacteremia (SAB) in children hospitalized in Australia and New Zealand over 24 months (2017-2018). Results: Overall, 552 SABs were identified (incidence 4.4/100 000/year). Indigenous children, those from lower socioeconomic areas and neonates were overrepresented. Although 90-day mortality was infrequent, one-third experienced the composite of: length of stay >30 days (26%), intensive care unit admission (20%), relapse (4%), or death (3%). Predictors of mortality included prematurity (adjusted odds ratio [aOR],16.8; 95% confidence interval [CI], 1.6-296.9), multifocal infection (aOR, 22.6; CI, 1.4-498.5), necrotizing pneumonia (aOR, 38.9; CI, 1.7-1754.6), multiorgan dysfunction (aOR, 26.5; CI, 4.1-268.8), and empiric vancomycin (aOR, 15.7; CI, 1.6-434.4); while infectious diseases (ID) consultation (aOR, 0.07; CI. 004-.9) was protective. Neither MRSA nor vancomycin trough targets impacted survival; however, empiric vancomycin was associated with nephrotoxicity (OR, 3.1; 95% CI 1.3-8.1). Conclusions: High SAB incidence was demonstrated and for the first time in a pediatric setting, necrotizing pneumonia and multifocal infection were predictors of mortality, while ID consultation was protective. The need to reevaluate pediatric vancomycin trough targets and limit unnecessary empiric vancomycin exposure to reduce poor outcomes and nephrotoxicity is highlighted. One in 3 children experienced considerable SAB morbidity; therefore, pediatric inclusion in future SAB comparator trials is paramount to improve outcomes.
KW - Anti-Bacterial Agents/therapeutic use
KW - Bacteremia/drug therapy
KW - Child
KW - Cross-Sectional Studies
KW - Humans
KW - Infant, Newborn
KW - Methicillin-Resistant Staphylococcus aureus
KW - Prospective Studies
KW - Retrospective Studies
KW - Staphylococcal Infections/drug therapy
KW - Staphylococcus aureus
KW - outcomes
KW - pediatrics
KW - mortality
KW - bacteremia
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U2 - 10.1093/cid/ciab510
DO - 10.1093/cid/ciab510
M3 - Article
C2 - 34089594
SN - 1058-4838
VL - 74
SP - 604
EP - 613
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 4
ER -