Staphylococcus aureus Bacteremia in Children: Antibiotic Resistance and Mortality

Oren Gordon, Matan J. Cohen, Itai Gross, Sharon Amit, Dina Averbuch, Dan Engelhard, Aaron Milstone, Allon E. Moses

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Staphylococcus aureus (SA) is a major cause of bacteremia in children. Methicillin-resistant SA (MRSA) is considered a public health threat; however, the differences in the prognosis of children with methicillin-susceptible SA (MSSA) versus MRSA bacteremia are not well defined. METHODS: Data from all SA bacteremia events in children (0-16 years) from 2002 to 2016 in a single Israeli tertiary center were collected. Positive cultures within 48 hours of hospitalization were considered community associated (CA). Those obtained afterward or from children hospitalized within the previous year were considered health-care associated (HA). RESULTS: We recorded 427 events, 284 (66%) were HA, 64 (15%) were MRSA and 9 (2%) were CA-MRSA. There was no increase in MRSA during the study period. In-hospital, 30-day and 1-year mortality were 3% (12 cases), 3.5% (16 cases), and 12% (50 cases), respectively. A multivariable analysis controlling for demographics, admitting department and prior morbidity showed an increased 1-year mortality in children with HA bacteremia (hazard ratio [HR] 4.1; 95% confidence interval [CI]: 1.3-12) and prior chronic disease (HR 3.4; 95% CI 1.2 to 9.0). MRSA was not independently associated with increased one-year mortality compared with MSSA: HR (95% CI: 1.4 [0.6-3.1]). CONCLUSIONS: Short-term pediatric mortality after SA bacteremia is low. HA-SA bacteremia has an increased long-term risk for mortality, particularly in children with chronic diseases. Our data suggest mortality was not increased for MRSA compared with MSSA bacteremia. The very low rate of CA-MRSA bacteremia justifies the current practice not to include glycopeptides in the empiric treatment of CA bacteremia in Israel.

Original languageEnglish (US)
Pages (from-to)459-463
Number of pages5
JournalThe Pediatric infectious disease journal
Volume38
Issue number5
DOIs
StatePublished - May 1 2019

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Microbial Drug Resistance
Bacteremia
Staphylococcus aureus
Methicillin Resistance
Mortality
Methicillin
Delivery of Health Care
Confidence Intervals
Methicillin-Resistant Staphylococcus aureus
Hospital Admitting Department
Chronic Disease
Hospitalized Child
Glycopeptides
Israel
Hospitalization
Public Health
Demography
Pediatrics
Morbidity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Gordon, O., Cohen, M. J., Gross, I., Amit, S., Averbuch, D., Engelhard, D., ... Moses, A. E. (2019). Staphylococcus aureus Bacteremia in Children: Antibiotic Resistance and Mortality. The Pediatric infectious disease journal, 38(5), 459-463. https://doi.org/10.1097/INF.0000000000002202

Staphylococcus aureus Bacteremia in Children : Antibiotic Resistance and Mortality. / Gordon, Oren; Cohen, Matan J.; Gross, Itai; Amit, Sharon; Averbuch, Dina; Engelhard, Dan; Milstone, Aaron; Moses, Allon E.

In: The Pediatric infectious disease journal, Vol. 38, No. 5, 01.05.2019, p. 459-463.

Research output: Contribution to journalArticle

Gordon, O, Cohen, MJ, Gross, I, Amit, S, Averbuch, D, Engelhard, D, Milstone, A & Moses, AE 2019, 'Staphylococcus aureus Bacteremia in Children: Antibiotic Resistance and Mortality', The Pediatric infectious disease journal, vol. 38, no. 5, pp. 459-463. https://doi.org/10.1097/INF.0000000000002202
Gordon, Oren ; Cohen, Matan J. ; Gross, Itai ; Amit, Sharon ; Averbuch, Dina ; Engelhard, Dan ; Milstone, Aaron ; Moses, Allon E. / Staphylococcus aureus Bacteremia in Children : Antibiotic Resistance and Mortality. In: The Pediatric infectious disease journal. 2019 ; Vol. 38, No. 5. pp. 459-463.
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abstract = "BACKGROUND: Staphylococcus aureus (SA) is a major cause of bacteremia in children. Methicillin-resistant SA (MRSA) is considered a public health threat; however, the differences in the prognosis of children with methicillin-susceptible SA (MSSA) versus MRSA bacteremia are not well defined. METHODS: Data from all SA bacteremia events in children (0-16 years) from 2002 to 2016 in a single Israeli tertiary center were collected. Positive cultures within 48 hours of hospitalization were considered community associated (CA). Those obtained afterward or from children hospitalized within the previous year were considered health-care associated (HA). RESULTS: We recorded 427 events, 284 (66{\%}) were HA, 64 (15{\%}) were MRSA and 9 (2{\%}) were CA-MRSA. There was no increase in MRSA during the study period. In-hospital, 30-day and 1-year mortality were 3{\%} (12 cases), 3.5{\%} (16 cases), and 12{\%} (50 cases), respectively. A multivariable analysis controlling for demographics, admitting department and prior morbidity showed an increased 1-year mortality in children with HA bacteremia (hazard ratio [HR] 4.1; 95{\%} confidence interval [CI]: 1.3-12) and prior chronic disease (HR 3.4; 95{\%} CI 1.2 to 9.0). MRSA was not independently associated with increased one-year mortality compared with MSSA: HR (95{\%} CI: 1.4 [0.6-3.1]). CONCLUSIONS: Short-term pediatric mortality after SA bacteremia is low. HA-SA bacteremia has an increased long-term risk for mortality, particularly in children with chronic diseases. Our data suggest mortality was not increased for MRSA compared with MSSA bacteremia. The very low rate of CA-MRSA bacteremia justifies the current practice not to include glycopeptides in the empiric treatment of CA bacteremia in Israel.",
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AU - Engelhard, Dan

AU - Milstone, Aaron

AU - Moses, Allon E.

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