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Multicenter Study
. 2017 Jun;139(6):e20170183.
doi: 10.1542/peds.2017-0183. Epub 2017 May 5.

Epidemiology of Methicillin-Resistant Staphylococcus aureus Bacteremia in Children

Rana F Hamdy  1 , Alice J Hsu  2 , Chris Stockmann  3 , Jared A Olson  4 , Matthew Bryan  5   6 , Adam L Hersh  3 , Pranita D Tamma  7 , Jeffrey S Gerber  5   6
Affiliations
Multicenter Study

Epidemiology of Methicillin-Resistant Staphylococcus aureus Bacteremia in Children

Rana F Hamdy et al. Pediatrics. 2017 Jun.

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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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flow diagram of children with MRSA bacteremia. a Not mutually exclusive.
FIGURE 2
FIGURE 2
Distribution of the duration of MRSA bacteremia.
FIGURE 3
FIGURE 3
Proportion of children with complications or death, by duration of MRSA bacteremia. ECMO, extracorporeal membrane oxygenation.
See this image and copyright information in PMC

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