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

Anita J Campbell; Laila S Al Yazidi; Linny K Phuong; Clare Leung; Emma J Best; Rachel H Webb; Lesley Voss; Eugene Athan; Philip N Britton; Penelope A Bryant; Coen T Butters; Jonathan R Carapetis; Natasha S Ching; Geoffrey W Coombs; Denise A Daley; Joshua R Francis; Te-Yu Hung; Shakeel Mowlaboccus; Clare Nourse; Samar Ojaimi; Alex Tai; Nan Vasilunas; Brendan McMullan; Christopher C Blyth; Asha C Bowen

doi:10.1093/cid/ciab510

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

Clin Infect Dis. 2022 Mar 1;74(4):604-613. doi: 10.1093/cid/ciab510.

Authors

Anita J Campbell^{1

2

3}, Laila S Al Yazidi^{4

5

6}, Linny K Phuong^{7

8}, Clare Leung⁹, Emma J Best^{10

11

12}, Rachel H Webb^{10

12

13}, Lesley Voss^{10

12}, Eugene Athan^{14

15}, Philip N Britton^{6

16}, Penelope A Bryant^{7

8}, Coen T Butters⁷, Jonathan R Carapetis^{1

2

3}, Natasha S Ching^{17

18

19}, Geoffrey W Coombs^{20

21}, Denise A Daley^{20

22}, Joshua R Francis^{23

24}, Te-Yu Hung²⁴, Shakeel Mowlaboccus^{21

25}, Clare Nourse^{26

27}, Samar Ojaimi^{17

18}, Alex Tai¹⁴, Nan Vasilunas²⁸, Brendan McMullan^{5

29

30}, Christopher C Blyth^{1

2

3

31}, Asha C Bowen^{1

2

3

23}

Affiliations

¹ Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia.
² Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.
³ School of Medicine, University of Western Australia, Perth, Australia.
⁴ Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.
⁵ Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia.
⁶ Children's Department of Infectious Diseases and Microbiology, Children's Hospital at Westmead, New South Wales, Australia.
⁷ Department of General Medicine, Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia.
⁸ Infection and Immunity Group, Murdoch Children's Research Institute, Melbourne, Australia.
⁹ Department of Paediatrics, Wagga Wagga Base Hospital, Wagga Wagga, Australia.
¹⁰ Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.
¹¹ National Immunisation Advisory Centre, University of Auckland, Auckland, New Zealand.
¹² Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand.
¹³ Department of Paediatrics, Kidz First Hospital, Auckland, New Zealand.
¹⁴ Department of Infectious Disease, Barwon Health, Geelong, Australia.
¹⁵ School of Medicine, Deakin University, Geelong, Australia.
¹⁶ Sydney Medical School and Marie Bashir Institute, University of Sydney, Sydney, Australia.
¹⁷ Infection and Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia.
¹⁸ Department of Paediatrics, Monash University, Clayton, Australia.
¹⁹ Department of General Paediatrics, Monash Children's Hospital, Monash Health, Melbourne, Australia.
²⁰ Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Royal Perth Hospital and Fiona Stanley Hospital, Perth, Western Australia.
²¹ College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia.
²² Australian Group on Antimicrobial Resistance, Australian Commission on Safety and Quality in Healthcare, Sydney, Australia.
²³ Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
²⁴ Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.
²⁵ School of Biomedical Sciences, University of Western Australia, Perth, Australia.
²⁶ Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia.
²⁷ Faculty of Medicine, University of Queensland, Queensland, Australia.
²⁸ Infectious Diseases Department, Women's and Children's Hospital, Adelaide, Australia.
²⁹ School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
³⁰ National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia.
³¹ Department of Microbiology, Pathest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia.

PMID: 34089594
DOI: 10.1093/cid/ciab510

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 (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.

Keywords: Staphylococcus aureus; bacteremia; mortality; outcomes; pediatrics.

Publication types

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

MeSH terms

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
Staphylococcal Infections* / epidemiology
Staphylococcus aureus

Substances

Anti-Bacterial Agents

Grants and funding

APP1133670/National Health and Medical Research Council