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Epidemiology and Mortality of Staphylococcus aureus Bacteremia in Australian and New Zealand Children.
JAMA Pediatr 2016; 170(10):979-986JP

Abstract

Importance

Staphylococcus aureus bacteremia (SAB) in children causes significant morbidity and mortality, but the epidemiology in children is not well characterized.

Objective

To describe the epidemiology of SAB in children and adolescents younger than 18 years from Australia and New Zealand.

Design, Setting, and Participants

A prospective cohort study, using data from the Australian New Zealand Cooperative on Outcomes in Staphylococcal Sepsis cohort for 1153 children with SAB from birth to less than 18 years in pediatric and general hospitals across Australia and New Zealand, collected between January 1, 2007, and December 31, 2012. Multivariate analysis was performed to identify risk factors for mortality. Incidence calculations were calculated separately for Australasian children younger than 15 years using postcode population denominator data from Australian and New Zealand census data.

Main Outcomes and Measures

Demographic data, hospital length of stay, principal diagnosis, place of SAB onset (community or hospital), antibiotic susceptibility and principal antibiotic treatment, and 7- and 30-day mortality.

Results

Of the 1153 children with SAB, complete outcome data were available for 1073 children (93.1%); of these, males accounted for 684 episodes (63.7%) of SAB. The median age was 57 months (interquartile range, 2 months to 12 years). The annual incidence of SAB for Australian children was 8.3 per 100 000 population and was higher in indigenous children (incident rate ratio, 3.0 [95% CI, 2.4-3.7]), and the incidence for New Zealand children was 14.4 per 100 000 population and was higher in Māori children (incident rate ratio, 5.4 [95% CI, 4.1-7.0]). Community-onset SAB occurred in 761 cases (70.9%), and 142 cases (13.2%) of the infections were methicillin-resistant S aureus (MRSA). Bone or joint infection was most common with 348 cases (32.4%), and endocarditis was uncommon with 30 cases (2.8%). Seven- and 30-day mortality rates were 2.6% (n = 28) and 4.7% (n = 50), respectively. Risk factors for mortality were age younger than 1 year; Māori or Pacific ethnicity; endocarditis, pneumonia, or sepsis; and receiving no treatment or treatment with vancomycin. Mortality was 14.0% (6 of 43) in children with methicillin-susceptible S aureus (MSSA) treated with vancomycin compared with 2.6% (22 of 851) in children treated with alternative agents (OR, 6.1 [95% CI, 1.9-16.7]). MRSA infection was associated with increased length of stay but not mortality.

Conclusions and Relevance

In this large cohort study of the epidemiology of SAB in children, death was uncommon, but the incidence was higher for infants and varied by treatment, ethnicity, and clinical presentation. This study provides important information on the epidemiology of SAB in children and risk factors for mortality.

Authors+Show Affiliations

Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia2School of Women's and Children's Health, University of New South Wales, New South Wales, Australia.Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia4Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia5Menzies School of Health Research, Darwin, Northern Territory, Australia6School of Pediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia.Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia4Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia6School of Pediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia7Department of Microbiology, Princess Margaret Hospital, PathWest Laboratory Medicine, Western Australia, Australia.Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital Camperdown, Sydney, New South Wales, Australia.Monash Infectious Diseases, Monash University, Monash Health, Victoria, Australia.Department of Infection and Immunity, Monash Children's Hospital, Department of Pediatrics, Monash University, Victoria, Australia.Department of Pediatric Infectious Disease, Starship Children's Hospital, Auckland, New Zealand.Microbiology Department, LabPlus, Auckland Hospital, Auckland, New Zealand.Department of Microbiology and Infectious Diseases, South Australia Pathology, Women's and Children's Hospital, North Adelaide, South Australia, Australia.Menzies School of Health Research, Darwin, Northern Territory, Australia14Royal Darwin Hospital, Darwin, Northern Territory, Australia.Department of Anatomy and Pathology, University of Adelaide, Adelaide, South Australia, Australia16Department of Pediatrics, University of Adelaide, Adelaide, South Australia, Australia17Department of Molecular and Cellular Biology, University of Adelaide, Adelaide, South Australia, Australia18Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27533601

Citation

McMullan, Brendan J., et al. "Epidemiology and Mortality of Staphylococcus Aureus Bacteremia in Australian and New Zealand Children." JAMA Pediatrics, vol. 170, no. 10, 2016, pp. 979-986.
McMullan BJ, Bowen A, Blyth CC, et al. Epidemiology and Mortality of Staphylococcus aureus Bacteremia in Australian and New Zealand Children. JAMA Pediatr. 2016;170(10):979-986.
McMullan, B. J., Bowen, A., Blyth, C. C., Van Hal, S., Korman, T. M., Buttery, J., ... Turnidge, J. (2016). Epidemiology and Mortality of Staphylococcus aureus Bacteremia in Australian and New Zealand Children. JAMA Pediatrics, 170(10), pp. 979-986. doi:10.1001/jamapediatrics.2016.1477.
McMullan BJ, et al. Epidemiology and Mortality of Staphylococcus Aureus Bacteremia in Australian and New Zealand Children. JAMA Pediatr. 2016 Oct 1;170(10):979-986. PubMed PMID: 27533601.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemiology and Mortality of Staphylococcus aureus Bacteremia in Australian and New Zealand Children. AU - McMullan,Brendan J, AU - Bowen,Asha, AU - Blyth,Christopher C, AU - Van Hal,Sebastiaan, AU - Korman,Tony M, AU - Buttery,Jim, AU - Voss,Lesley, AU - Roberts,Sally, AU - Cooper,Celia, AU - Tong,Steven Y C, AU - Turnidge,John, PY - 2016/8/18/pubmed PY - 2017/5/30/medline PY - 2016/8/18/entrez SP - 979 EP - 986 JF - JAMA pediatrics JO - JAMA Pediatr VL - 170 IS - 10 N2 - Importance: Staphylococcus aureus bacteremia (SAB) in children causes significant morbidity and mortality, but the epidemiology in children is not well characterized. Objective: To describe the epidemiology of SAB in children and adolescents younger than 18 years from Australia and New Zealand. Design, Setting, and Participants: A prospective cohort study, using data from the Australian New Zealand Cooperative on Outcomes in Staphylococcal Sepsis cohort for 1153 children with SAB from birth to less than 18 years in pediatric and general hospitals across Australia and New Zealand, collected between January 1, 2007, and December 31, 2012. Multivariate analysis was performed to identify risk factors for mortality. Incidence calculations were calculated separately for Australasian children younger than 15 years using postcode population denominator data from Australian and New Zealand census data. Main Outcomes and Measures: Demographic data, hospital length of stay, principal diagnosis, place of SAB onset (community or hospital), antibiotic susceptibility and principal antibiotic treatment, and 7- and 30-day mortality. Results: Of the 1153 children with SAB, complete outcome data were available for 1073 children (93.1%); of these, males accounted for 684 episodes (63.7%) of SAB. The median age was 57 months (interquartile range, 2 months to 12 years). The annual incidence of SAB for Australian children was 8.3 per 100 000 population and was higher in indigenous children (incident rate ratio, 3.0 [95% CI, 2.4-3.7]), and the incidence for New Zealand children was 14.4 per 100 000 population and was higher in Māori children (incident rate ratio, 5.4 [95% CI, 4.1-7.0]). Community-onset SAB occurred in 761 cases (70.9%), and 142 cases (13.2%) of the infections were methicillin-resistant S aureus (MRSA). Bone or joint infection was most common with 348 cases (32.4%), and endocarditis was uncommon with 30 cases (2.8%). Seven- and 30-day mortality rates were 2.6% (n = 28) and 4.7% (n = 50), respectively. Risk factors for mortality were age younger than 1 year; Māori or Pacific ethnicity; endocarditis, pneumonia, or sepsis; and receiving no treatment or treatment with vancomycin. Mortality was 14.0% (6 of 43) in children with methicillin-susceptible S aureus (MSSA) treated with vancomycin compared with 2.6% (22 of 851) in children treated with alternative agents (OR, 6.1 [95% CI, 1.9-16.7]). MRSA infection was associated with increased length of stay but not mortality. Conclusions and Relevance: In this large cohort study of the epidemiology of SAB in children, death was uncommon, but the incidence was higher for infants and varied by treatment, ethnicity, and clinical presentation. This study provides important information on the epidemiology of SAB in children and risk factors for mortality. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/27533601/Epidemiology_and_Mortality_of_Staphylococcus_aureus_Bacteremia_in_Australian_and_New_Zealand_Children_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2016.1477 DB - PRIME DP - Unbound Medicine ER -