Pediatric Staphylococcus aureus bacteremia: clinical spectrum and predictors of poor outcome
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Pediatric Staphylococcus aureus bacteremia: clinical spectrum and predictors of poor outcome

Anita J Campbell;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Laila S Al Yazidi;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Linny K Phuong;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Clare Leung;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Emma J Best;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Rachel H Webb;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Lesley Voss;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Eugene Athan;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Philip N Britton;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Penelope A Bryant;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Coen T Butters;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Jonathan R Carapetis;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Natasha S Ching;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Geoffrey W Coombs;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Denise Daley;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Joshua Francis;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Te-Yu Hung;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Shakeel Mowlaboccus;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Clare Nourse;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Samar Ojaimi;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Alex Tai;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Nan Vasilunas;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Brendan McMullan;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Christopher C Blyth;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);Asha C Bowen;on behalf of the Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID);
clinical infectious diseases 2021 Vol. Advance Article pp. 1-1
106
campbell2021clinicalpediatric

Abstract

Abstract Background Staphylococcus aureus is a common cause of bacteremia, yet the epidemiology, and predictors of poor outcome remain inadequately defined in childhood. Methods ISAIAH is a prospective, cross-sectional study of S. aureus bacteremia (SAB), in children hospitalized in Australia and New Zealand, over 24-months (2017–2018). Results Overall, 552 SABs were identified, (incidence 4.4/100,000/yr [95% confidence interval (CI) 2.2-8.8]), with methicillin-susceptible (84%), community onset (78%) infection predominating. Indigenous children (8.1/100,000/yr [CI 4.8-14.4]), those from lower-socioeconomic areas (5.5/100,000/yr [CI 2.8-10.2]) and neonates (6.6/100,000/yr (CI 3.4-11.7) were over-represented. Although 90-day mortality was infrequent, one-third experienced the composite of: length of stay >30 days (26%), ICU admission (20%), relapse (4%), or death (3%). Predictors of mortality included prematurity (aOR 16.8 [CI 1.6-296.9]), multifocal infection (aOR 22.6 [CI 1.4-498.5]), necrotizing pneumonia (aOR 38.9 [CI 1.7 – 1754.6]), multiorgan dysfunction (aOR 26.5 [CI 4.1-268.8]) and empiric-vancomycin (aOR 15.7 [CI 1.6-434.4]); whilst Infectious Diseases (ID) consultation (aOR 0.07 [CI 0.004-0.9]) was protective. Neither MRSA nor vancomycin trough-targets impacted survival; however, empiric-vancomycin was associated with significant nephrotoxicity (OR 3.1 [CI 1.3-8.1]). Conclusions High SAB incidence was demonstrated, with at-risk populations identified for future prioritized care. For the first time in a pediatric setting, necrotizing pneumonia and multifocal infection were predictors of mortality, whilst ID consultation was protective. The need to re-evaluate pediatric vancomycin trough-targets and limit unnecessary empiric-vancomycin exposure, to reduce poor outcomes and nephrotoxicity is highlighted. One in three children experienced considerable SAB morbidity, therefore pediatric inclusion in future SAB comparator trials is paramount to improve outcomes. Staphylococcus aureus, pediatrics, bacteremia, outcomes, mortality This content is only available as a PDF. © 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. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

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