From the Department of Clinical Microbiology and Infectious Diseases.
Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Pediatr Infect Dis J. 2019 May;38(5):459-463. doi: 10.1097/INF.0000000000002202.
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.
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).
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]).
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.
金黄色葡萄球菌（SA）是儿童菌血症的主要病因。耐甲氧西林金黄色葡萄球菌（MRSA）被认为是公共卫生威胁；然而，耐甲氧西林金黄色葡萄球菌（MSSA）与 MRSA 菌血症患儿的预后差异尚不清楚。
收集了 2002 年至 2016 年期间以色列一家三级中心所有儿童（0-16 岁）的 SA 菌血症事件的数据。住院后 48 小时内培养的阳性标本被认为是社区获得性（CA）。随后获得的或来自前一年住院的患儿的标本被认为是与医疗保健相关的（HA）。
我们记录了 427 例事件，284 例（66%）为 HA，64 例（15%）为 MRSA，9 例（2%）为 CA-MRSA。在研究期间，MRSA 没有增加。院内、30 天和 1 年死亡率分别为 3%（12 例）、3.5%（16 例）和 12%（50 例）。在控制了人口统计学、入院科室和既往发病率的多变量分析中，HA 菌血症患儿（危险比[HR]4.1；95%置信区间[CI]：1.3-12）和既往慢性疾病（HR 3.4；95%CI 1.2 至 9.0）的 1 年死亡率增加。与 MSSA 相比，MRSA 与 1 年死亡率增加无关：HR（95%CI：1.4[0.6-3.1]）。
儿童金黄色葡萄球菌菌血症后短期死亡率较低。HA-SA 菌血症具有长期死亡风险增加的风险，特别是在患有慢性疾病的儿童中。我们的数据表明，MRSA 菌血症与 MSSA 菌血症相比，死亡率并未增加。CA-MRSA 菌血症的发生率非常低，这证明了目前在以色列不将糖肽类药物纳入 CA 菌血症经验性治疗的做法是合理的。
