Epidemiology of methicillin-resistant staphylococcus aureus bacteremia in children

Rana F. Hamdy, Alice J. Hsu, Chris Stockmann, Jared A. Olson, Matthew Bryan, Adam L. Hersh, Pranita Tamma, Jeffrey S. Gerber

Research output: Contribution to journalArticle

Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with high rates of treatment failure in adults. The epidemiology, clinical outcomes, and risk factors for treatment failure associated with MRSA bacteremia in children are poorly understood. Methods: Multicenter, retrospective cohort study of children ≤18 years hospitalized with MRSA bacteremia across 3 tertiary care children's hospitals from 2007 to 2014. Treatment failure was defined as persistent bacteremia >3 days, recurrence of bacteremia within 30 days, or attributable 30-day mortality. Potential risk factors for treatment failure, including the site of infection, vancomycin trough concentration, critical illness, and need for source control, were collected via manual chart review and evaluated using multivariable logistic regression. Results: Of 232 episodes of MRSA bacteremia, 72 (31%) experienced treatment failure and 23% developed complications, whereas 5 (2%) died within 30 days. Multivariable analysis of 174 children treated with vancomycin with steady-state vancomycin concentrations obtained found that catheter-related infections (odds ratio [OR], 0.36; 95% confidence interval [CI]: 0.13-0.94) and endovascular infections (OR, 4.35; 95% CI: 1.07-17.7) were associated with lower and higher odds of treatment failure, respectively, whereas a first vancomycin serum trough concentration <10 μg/mL was not associated with treatment failure (OR, 1.34; 95% CI, 0.49-3.66). Each additional day of bacteremia was associated with a 50% (95% CI: 26%-79%) increased odds of bacteremia-related complications. Conclusions: Hospitalized children with MRSA bacteremia frequently suffered treatment failure and complications, but mortality was low. The odds of bacteremia-related complications increased with each additional day of bacteremia, emphasizing the importance of achieving rapid sterilization.

Original languageEnglish (US)
Article numbere20170183
JournalPediatrics
Volume139
Issue number6
DOIs
StatePublished - Jun 1 2017

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Methicillin-Resistant Staphylococcus aureus
Bacteremia
Epidemiology
Treatment Failure
Vancomycin
Confidence Intervals
Odds Ratio
Catheter-Related Infections
Hospitalized Child
Mortality
Tertiary Healthcare
Infection
Critical Illness
Cohort Studies
Retrospective Studies
Logistic Models
Recurrence

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Hamdy, R. F., Hsu, A. J., Stockmann, C., Olson, J. A., Bryan, M., Hersh, A. L., ... Gerber, J. S. (2017). Epidemiology of methicillin-resistant staphylococcus aureus bacteremia in children. Pediatrics, 139(6), [e20170183]. https://doi.org/10.1542/peds.2017-0183

Epidemiology of methicillin-resistant staphylococcus aureus bacteremia in children. / Hamdy, Rana F.; Hsu, Alice J.; Stockmann, Chris; Olson, Jared A.; Bryan, Matthew; Hersh, Adam L.; Tamma, Pranita; Gerber, Jeffrey S.

In: Pediatrics, Vol. 139, No. 6, e20170183, 01.06.2017.

Research output: Contribution to journalArticle

Hamdy, RF, Hsu, AJ, Stockmann, C, Olson, JA, Bryan, M, Hersh, AL, Tamma, P & Gerber, JS 2017, 'Epidemiology of methicillin-resistant staphylococcus aureus bacteremia in children', Pediatrics, vol. 139, no. 6, e20170183. https://doi.org/10.1542/peds.2017-0183
Hamdy RF, Hsu AJ, Stockmann C, Olson JA, Bryan M, Hersh AL et al. Epidemiology of methicillin-resistant staphylococcus aureus bacteremia in children. Pediatrics. 2017 Jun 1;139(6). e20170183. https://doi.org/10.1542/peds.2017-0183
Hamdy, Rana F. ; Hsu, Alice J. ; Stockmann, Chris ; Olson, Jared A. ; Bryan, Matthew ; Hersh, Adam L. ; Tamma, Pranita ; Gerber, Jeffrey S. / Epidemiology of methicillin-resistant staphylococcus aureus bacteremia in children. In: Pediatrics. 2017 ; Vol. 139, No. 6.
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abstract = "Background: Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with high rates of treatment failure in adults. The epidemiology, clinical outcomes, and risk factors for treatment failure associated with MRSA bacteremia in children are poorly understood. Methods: Multicenter, retrospective cohort study of children ≤18 years hospitalized with MRSA bacteremia across 3 tertiary care children's hospitals from 2007 to 2014. Treatment failure was defined as persistent bacteremia >3 days, recurrence of bacteremia within 30 days, or attributable 30-day mortality. Potential risk factors for treatment failure, including the site of infection, vancomycin trough concentration, critical illness, and need for source control, were collected via manual chart review and evaluated using multivariable logistic regression. Results: Of 232 episodes of MRSA bacteremia, 72 (31{\%}) experienced treatment failure and 23{\%} developed complications, whereas 5 (2{\%}) died within 30 days. Multivariable analysis of 174 children treated with vancomycin with steady-state vancomycin concentrations obtained found that catheter-related infections (odds ratio [OR], 0.36; 95{\%} confidence interval [CI]: 0.13-0.94) and endovascular infections (OR, 4.35; 95{\%} CI: 1.07-17.7) were associated with lower and higher odds of treatment failure, respectively, whereas a first vancomycin serum trough concentration <10 μg/mL was not associated with treatment failure (OR, 1.34; 95{\%} CI, 0.49-3.66). Each additional day of bacteremia was associated with a 50{\%} (95{\%} CI: 26{\%}-79{\%}) increased odds of bacteremia-related complications. Conclusions: Hospitalized children with MRSA bacteremia frequently suffered treatment failure and complications, but mortality was low. The odds of bacteremia-related complications increased with each additional day of bacteremia, emphasizing the importance of achieving rapid sterilization.",
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