Kumarachandran Ganesh, Johnson Jennifer Kristie, Shirley Debbie-Ann, Graffunder Eileen, Heil Emily L
J Pediatr Pharmacol Ther. 2017 May-Jun;22(3):218-226. doi: 10.5863/1551-6776-22.3.218.
Staphylococcus aureus bacteremia is a common infection, associated with significant morbidity and mortality in children. Factors associated with adverse treatment outcomes are poorly understood in the pediatric population.
Our study compared clinical and microbiologic characteristics of children admitted during a 5-year period (2007-2012) to a large university-based hospital and found to have S aureus bacteremia with outcome measures, in order to identify risk factors associated with treatment failure (defined as 30-day mortality, delayed microbiologic resolution, or recurrence of S aureus bacteremia within 60 days of completing effective antibiotic therapy).
In all, 71 patients were found to have S aureus bacteremia, and of these, 17 patients (24%) experienced treatment failure. Based on the logistic regression model, only high vancomycin minimum inhibitory concentration in combination with a high-risk source of infection (i.e., infected graft or device, intra-abdominal infection, or respiratory tract infection) was significantly associated with risk of treatment failure.
Infection associated with a high-risk source may increase the chance of treatment failure in pediatric patients with S aureus bacteremia. Vancomycin minimum inhibitory concentration alone was not found to be a predictor of treatment outcomes.
金黄色葡萄球菌血症是一种常见感染，与儿童的显著发病率和死亡率相关。在儿科人群中，与不良治疗结果相关的因素尚不清楚。
我们的研究比较了一所大型大学附属医院在5年期间（2007 - 2012年）收治的、被发现患有金黄色葡萄球菌血症的儿童的临床和微生物学特征，并将其与治疗结果指标进行对比，以确定与治疗失败相关的危险因素（治疗失败定义为30天死亡率、微生物学缓解延迟或在完成有效抗生素治疗后60天内金黄色葡萄球菌血症复发）。
总共发现71例患者患有金黄色葡萄球菌血症，其中17例患者（24%）经历了治疗失败。基于逻辑回归模型，只有高万古霉素最低抑菌浓度与高风险感染源（即感染的移植物或装置、腹腔内感染或呼吸道感染）相结合，才与治疗失败风险显著相关。
与高风险源相关的感染可能会增加患有金黄色葡萄球菌血症的儿科患者治疗失败的几率。单独的万古霉素最低抑菌浓度未被发现是治疗结果的预测指标。
