Pediatric Staphylococcus aureus Bacteremia: Clinical Spectrum and Predictors of Poor Outcome.

Anti-Bacterial Agents / therapeutic use Bacteremia / drug therapy Child Cross-Sectional Studies Humans Infant, Newborn Methicillin-Resistant Staphylococcus aureus Prospective Studies Retrospective Studies Staphylococcal Infections / drug therapy Staphylococcus aureus
Staphylococcus aureus bacteremia mortality outcomes pediatrics

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213

Informations de publication

Date de publication:
01 03 2022
Historique:
received: 08 03 2021
pubmed: 6 6 2021
medline: 15 3 2022
entrez: 5 6 2021
Statut: ppublish

Résumé

Staphylococcus aureus is a common cause of bacteremia, yet the epidemiology and predictors of poor outcome remain inadequately defined in childhood. 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). 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). 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.

Sections du résumé

BACKGROUND
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.

Identifiants

DOI: 10.1093/cid/ciab510 PMID: 34089594
pubmed: 34089594
pii: 6293981
doi: 10.1093/cid/ciab510
doi:

Substances chimiques

Anti-Bacterial Agents 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

604-613

Subventions

Organisme : National Health and Medical Research Council
ID : APP1133670

Informations de copyright

© 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.

Auteurs

Anita J Campbell (AJ)

Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia.
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.
School of Medicine, University of Western Australia, Perth, Australia.

Laila S Al Yazidi (LS)

Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.
Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia.
Children's Department of Infectious Diseases and Microbiology, Children's Hospital at Westmead, New South Wales, Australia.

Linny K Phuong (LK)

Department of General Medicine, Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia.
Infection and Immunity Group, Murdoch Children's Research Institute, Melbourne, Australia.

Clare Leung (C)

Department of Paediatrics, Wagga Wagga Base Hospital, Wagga Wagga, Australia.

Emma J Best (EJ)

Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.
National Immunisation Advisory Centre, University of Auckland, Auckland, New Zealand.
Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand.

Rachel H Webb (RH)

Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.
Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand.
Department of Paediatrics, Kidz First Hospital, Auckland, New Zealand.

Lesley Voss (L)

Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.
Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand.

Eugene Athan (E)

Department of Infectious Disease, Barwon Health, Geelong, Australia.
School of Medicine, Deakin University, Geelong, Australia.

Philip N Britton (PN)

Children's Department of Infectious Diseases and Microbiology, Children's Hospital at Westmead, New South Wales, Australia.
Sydney Medical School and Marie Bashir Institute, University of Sydney, Sydney, Australia.

Penelope A Bryant (PA)

Department of General Medicine, Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia.
Infection and Immunity Group, Murdoch Children's Research Institute, Melbourne, Australia.

Coen T Butters (CT)

Department of General Medicine, Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia.

Jonathan R Carapetis (JR)

Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia.
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.
School of Medicine, University of Western Australia, Perth, Australia.

Natasha S Ching (NS)

Infection and Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia.
Department of Paediatrics, Monash University, Clayton, Australia.
Department of General Paediatrics, Monash Children's Hospital, Monash Health, Melbourne, Australia.

Geoffrey W Coombs (GW)

Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Royal Perth Hospital and Fiona Stanley Hospital, Perth, Western Australia.
College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia.

Denise A Daley (DA)

Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Royal Perth Hospital and Fiona Stanley Hospital, Perth, Western Australia.
Australian Group on Antimicrobial Resistance, Australian Commission on Safety and Quality in Healthcare, Sydney, Australia.

Joshua R Francis (JR)

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.

Te-Yu Hung (TY)

Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.

Shakeel Mowlaboccus (S)

College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia.
School of Biomedical Sciences, University of Western Australia, Perth, Australia.

Clare Nourse (C)

Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia.
Faculty of Medicine, University of Queensland, Queensland, Australia.

Samar Ojaimi (S)

Infection and Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia.
Department of Paediatrics, Monash University, Clayton, Australia.

Alex Tai (A)

Department of Infectious Disease, Barwon Health, Geelong, Australia.

Nan Vasilunas (N)

Infectious Diseases Department, Women's and Children's Hospital, Adelaide, Australia.

Brendan McMullan (B)

Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia.
School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia.

Christopher C Blyth (CC)

Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia.
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.
School of Medicine, University of Western Australia, Perth, Australia.
Department of Microbiology, Pathest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia.

Asha C Bowen (AC)

Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia.
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.
School of Medicine, University of Western Australia, Perth, Australia.
Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Pediatric Staphylococcus aureus Bacteremia:...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Inflammation › Sepsie › Bactériémie › Pediatric Staphylococcus aureus Bacteremia:...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Pediatric Staphylococcus aureus Bacteremia:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études transversales › Pediatric Staphylococcus aureus Bacteremia:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Pediatric Staphylococcus aureus Bacteremia:...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › Pediatric Staphylococcus aureus Bacteremia:...
questionsmedicales.fr › Bactéries › Bactéries à Gram positif › Cocci à Gram positif › Staphylococcaceae › Staphylococcus › Staphylococcus aureus › Staphylococcus aureus résistant à la méticilline › Pediatric Staphylococcus aureus Bacteremia:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Pediatric Staphylococcus aureus Bacteremia:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Pediatric Staphylococcus aureus Bacteremia:...
questionsmedicales.fr › Infection › Infections bactériennes et mycoses › Infections bactériennes › Infections bactériennes à Gram positif › Infections à staphylocoques › Pediatric Staphylococcus aureus Bacteremia:...
questionsmedicales.fr › Bactéries › Bactéries à Gram positif › Cocci à Gram positif › Staphylococcaceae › Staphylococcus › Staphylococcus aureus › Pediatric Staphylococcus aureus Bacteremia:...