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Infection characteristics and treatment of Staphylococcus aureus bacteraemia at a tertiary children's hospital.
BMC Infect Dis 2018; 18(1):387BI

Abstract

BACKGROUND

Staphylococcus aureus bacteraemia (SAB) causes considerable morbidity and mortality in children. Despite this, its epidemiology and risk factors are poorly understood, with minimal paediatric clinical trial data available to guide clinicians in management. We conducted a pilot study to characterise SAB and validate a severity classification for use in future clinical trials.

METHODS

Patients with SAB were prospectively identified at Princess Margaret Hospital for Children (Perth, Western Australia) from May 2011 to December 2013. Retrospective data were collected from clinical and laboratory records. Cases were classified based on a priori defined criteria as simple (single or contiguous, peripheral site focus) or complex (multi-site, deep tissue, no focus or sepsis) and tested against risk factors and markers of severity of infection.

RESULTS

There were 49 cases of SAB (median age 7.7 years), with classification as simple (n = 30, 61%) and complex (n = 19, 39%) respectively. There were no deaths or relapses in our cohort. Only 10% of isolates were methicillin resistant S. aureus (MRSA), and none of these were healthcare-associated. Age, gender, Indigenous status, MRSA and healthcare-associated infections were not predictive of complex infection. Pre-existing malignancy was a risk factor for complex infection (p = 0.02). Complex infections were associated with a higher median maximum C reactive protein (216 mg/L vs 50 mg/L, p = < 0.001), longer median length of stay (42 vs 10 days, p = < 0.001) and longer duration of antibiotic therapy (43 vs 34 days, p = 0.03).

DISCUSSION

This is the first attempt to categorise paediatric SAB as simple versus complex, to guide clinicians in decision making.

CONCLUSIONS

There is a wide spectrum of disease severity in paediatric SAB, with maximum CRP, length of stay, and duration of therapy greater in those with complex disease. Distinct cohorts with simple and complex courses which may be a target for future clinical trials have been described.

Authors+Show Affiliations

Department of Infectious Diseases, Perth Children's Hospital, Hospital Ave, Nedlands, WA, 6009, Australia. a.munro@doctors.org.uk. Royal Hampshire County Hospital, Romsey Road, Winchester, Hampshire, SO22 5DG, UK. a.munro@doctors.org.uk.Department of Infectious Diseases, Perth Children's Hospital, Hospital Ave, Nedlands, WA, 6009, Australia. Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Roberts Road, Subiaco, WA, 6008, Australia. Department of Microbiology, PathWest Laboratory Medicine WA, Hospital Ave, Nedlands, WA, 6009, Australia. Centre for Child Health Research, School of Medicine, University of Western Australia, Nedlands, WA, 6009, Australia.Department of Infectious Diseases, Perth Children's Hospital, Hospital Ave, Nedlands, WA, 6009, Australia. Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Roberts Road, Subiaco, WA, 6008, Australia. Centre for Child Health Research, School of Medicine, University of Western Australia, Nedlands, WA, 6009, Australia.Department of Infectious Diseases, Perth Children's Hospital, Hospital Ave, Nedlands, WA, 6009, Australia. Asha.bowen@health.wa.gov.au. Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Roberts Road, Subiaco, WA, 6008, Australia. Asha.bowen@health.wa.gov.au. Centre for Child Health Research, School of Medicine, University of Western Australia, Nedlands, WA, 6009, Australia. Asha.bowen@health.wa.gov.au. Menzies School of Health Research, Charles Darwin University, Rocklands Drive, Tiwi, NT, 0810, Australia. Asha.bowen@health.wa.gov.au.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30097020

Citation

Munro, Alasdair P S., et al. "Infection Characteristics and Treatment of Staphylococcus Aureus Bacteraemia at a Tertiary Children's Hospital." BMC Infectious Diseases, vol. 18, no. 1, 2018, p. 387.
Munro APS, Blyth CC, Campbell AJ, et al. Infection characteristics and treatment of Staphylococcus aureus bacteraemia at a tertiary children's hospital. BMC Infect Dis. 2018;18(1):387.
Munro, A. P. S., Blyth, C. C., Campbell, A. J., & Bowen, A. C. (2018). Infection characteristics and treatment of Staphylococcus aureus bacteraemia at a tertiary children's hospital. BMC Infectious Diseases, 18(1), p. 387. doi:10.1186/s12879-018-3312-5.
Munro APS, et al. Infection Characteristics and Treatment of Staphylococcus Aureus Bacteraemia at a Tertiary Children's Hospital. BMC Infect Dis. 2018 08 10;18(1):387. PubMed PMID: 30097020.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Infection characteristics and treatment of Staphylococcus aureus bacteraemia at a tertiary children's hospital. AU - Munro,Alasdair P S, AU - Blyth,Christopher C, AU - Campbell,Anita J, AU - Bowen,Asha C, Y1 - 2018/08/10/ PY - 2017/08/20/received PY - 2018/08/03/accepted PY - 2018/8/12/entrez PY - 2018/8/12/pubmed PY - 2018/8/12/medline KW - Bacteraemia KW - Paediatric KW - Sepsis KW - Staphylococcus aureus SP - 387 EP - 387 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 18 IS - 1 N2 - BACKGROUND: Staphylococcus aureus bacteraemia (SAB) causes considerable morbidity and mortality in children. Despite this, its epidemiology and risk factors are poorly understood, with minimal paediatric clinical trial data available to guide clinicians in management. We conducted a pilot study to characterise SAB and validate a severity classification for use in future clinical trials. METHODS: Patients with SAB were prospectively identified at Princess Margaret Hospital for Children (Perth, Western Australia) from May 2011 to December 2013. Retrospective data were collected from clinical and laboratory records. Cases were classified based on a priori defined criteria as simple (single or contiguous, peripheral site focus) or complex (multi-site, deep tissue, no focus or sepsis) and tested against risk factors and markers of severity of infection. RESULTS: There were 49 cases of SAB (median age 7.7 years), with classification as simple (n = 30, 61%) and complex (n = 19, 39%) respectively. There were no deaths or relapses in our cohort. Only 10% of isolates were methicillin resistant S. aureus (MRSA), and none of these were healthcare-associated. Age, gender, Indigenous status, MRSA and healthcare-associated infections were not predictive of complex infection. Pre-existing malignancy was a risk factor for complex infection (p = 0.02). Complex infections were associated with a higher median maximum C reactive protein (216 mg/L vs 50 mg/L, p = < 0.001), longer median length of stay (42 vs 10 days, p = < 0.001) and longer duration of antibiotic therapy (43 vs 34 days, p = 0.03). DISCUSSION: This is the first attempt to categorise paediatric SAB as simple versus complex, to guide clinicians in decision making. CONCLUSIONS: There is a wide spectrum of disease severity in paediatric SAB, with maximum CRP, length of stay, and duration of therapy greater in those with complex disease. Distinct cohorts with simple and complex courses which may be a target for future clinical trials have been described. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/30097020/Infection_characteristics_and_treatment_of_Staphylococcus_aureus_bacteraemia_at_a_tertiary_children's_hospital_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-018-3312-5 DB - PRIME DP - Unbound Medicine ER -