Burke Robert E, Halpern Meira S, Baron Ellen Jo, Gutierrez Kathleen
Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Infect Control Hosp Epidemiol. 2009 Jul;30(7):636-44. doi: 10.1086/597521.
To evaluate the impact of methicillin-resistant Staphylococcus aureus on the prevalence of S. aureus bloodstream infection among children.
Retrospective analysis of demographic data, risk factors for infection, and clinical outcomes for children (age, less than 18 years) with S. aureus bacteremia hospitalized at a children's hospital during 2001-2006.
We identified 164 episodes of S. aureus bacteremia among 151 children. The prevalence of bacteremia due to methicillin-susceptible S. aureus during 2001-2003 was approximately the same as that during 2004-2006 (29 and 30 cases, respectively, per 10,000 hospitalized children [hereafter, "per 10,000 hospitalizations"]), but the prevalence of bacteremia due to methicillin-resistant S. aureus increased from 4 to 11 cases, respectively, per 10,000 hospitalizations (P=.015). A total of 48% of infections involved children who had S. aureus-positive blood cultures less than 3 days after hospital admission. Seventy-four percent of these children had a preexisting comorbidity. When the prevalence of S. aureus bacteremia was stratified by race, sex, or age, neonates hospitalized at birth and Hispanic children had significantly reduced risks of infection. Children younger than 1 year of age (excluding neonates hospitalized at birth) had an increased prevalence of hospital-onset S. aureus bacteremia. There was a disproportionate increase in the risk of S. aureus bacteremia for each additional week of hospitalization among children with hospital-onset S. aureus bacteremia. Children with methicillin-resistant S. aureus bacteremia had a longer hospital stay, were transferred to another facility at a greater rate than they were discharged home, and had a greater mortality rate, compared with children with methicillin-susceptible S. aureus bacteremia.
This study documents the prevalence of S. aureus bacteremia among children with a high risk for acquiring this infection, and it describes populations of children who are at higher risk for bacteremia due to either methicillin-susceptible or methicillin-resistant S. aureus. Methods to improve prevention of S. aureus bacteremia are needed for children with healthcare-associated risk factors for S. aureus bacteremia.
评估耐甲氧西林金黄色葡萄球菌对儿童金黄色葡萄球菌血流感染患病率的影响。
回顾性分析2001年至2006年期间在一家儿童医院住院的金黄色葡萄球菌菌血症患儿（年龄小于18岁）的人口统计学数据、感染危险因素和临床结局。
我们在151名儿童中确定了164例金黄色葡萄球菌菌血症发作。2001年至2003年期间，甲氧西林敏感金黄色葡萄球菌引起的菌血症患病率与2004年至2006年期间大致相同（每10000名住院儿童中分别为29例和30例[以下简称“每10000次住院”]），但耐甲氧西林金黄色葡萄球菌引起的菌血症患病率从每10000次住院4例增加到11例（P = 0.015）。共有48%的感染涉及入院后不到3天血培养金黄色葡萄球菌呈阳性的儿童。这些儿童中有74%患有先前存在的合并症。当按种族、性别或年龄对金黄色葡萄球菌菌血症患病率进行分层时，出生时住院的新生儿和西班牙裔儿童感染风险显著降低。1岁以下儿童（不包括出生时住院的新生儿）医院获得性金黄色葡萄球菌菌血症患病率增加。医院获得性金黄色葡萄球菌菌血症患儿每多住院一周，金黄色葡萄球菌菌血症风险增加不成比例。与甲氧西林敏感金黄色葡萄球菌菌血症患儿相比，耐甲氧西林金黄色葡萄球菌菌血症患儿住院时间更长，转至另一机构的比例高于出院回家的比例，死亡率更高。
本研究记录了易感染这种感染的高危儿童中金黄色葡萄球菌菌血症的患病率，并描述了因甲氧西林敏感或耐甲氧西林金黄色葡萄球菌而菌血症风险较高的儿童群体。对于有金黄色葡萄球菌菌血症医疗相关危险因素的儿童，需要采取方法来改善金黄色葡萄球菌菌血症的预防。
