Department of Pediatrics, Children's National Health System, Washington, DC.
Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr. 2019 May;208:214-220.e2. doi: 10.1016/j.jpeds.2018.12.002. Epub 2019 Mar 14.
To determine risk factors for complications in children with Staphylococcus aureus (S aureus) bacteremia, including methicillin resistance.
Single center, retrospective cohort study of children ≤18 years of age hospitalized with S aureus bacteremia. We compared clinical characteristics and outcomes between those with methicillin-sensitive S aureus (MSSA) and methicillin-resistant S aureus (MRSA) bacteremia. Multivariate regression models identified risk factors associated with developing complications and with longer duration of bacteremia.
We identified 394 episodes of S aureus bacteremia, 279 (70.8%) with MSSA, and 115 (29.2%) with MRSA. Primary site of infection was catheter-related in 34%, musculoskeletal in 30%, skin/soft tissue in 10.2%, pneumonia in 6.4%, and endovascular in 6.6%. Eight children (2.0%) died within 30 days because of S aureus bacteremia, 15 (3.5%) had recurrence within 30 days, and 38 (9.6%) had complications including septic emboli or a metastatic focus of infection. Methicillin resistance was associated with development of a complication (aOR 3.31; 95% CI 1.60-6.85), and catheter-related infections were less likely to be associated with a complication (aOR 0.40; 95% CI 0.15-1.03). In a Poisson regression analysis on duration of bacteremia, methicillin resistance, musculoskeletal infection, endovascular infection, black race, and delayed intervention for source control were significantly associated with longer duration of bacteremia.
In this cohort of children with S aureus bacteremia, MRSA infections ere associated with longer duration of bacteremia and a higher likelihood of complications.
确定金黄色葡萄球菌（S aureus）菌血症患儿并发症的危险因素，包括耐甲氧西林。
对 18 岁以下因金黄色葡萄球菌菌血症住院的儿童进行单中心回顾性队列研究。我们比较了耐甲氧西林金黄色葡萄球菌（MSSA）和耐甲氧西林金黄色葡萄球菌（MRSA）菌血症患儿的临床特征和结局。多变量回归模型确定了与并发症发展和菌血症持续时间较长相关的危险因素。
我们共发现 394 例金黄色葡萄球菌菌血症，其中 279 例（70.8%）为 MSSA，115 例（29.2%）为 MRSA。感染的主要部位为导管相关性占 34%，肌肉骨骼占 30%，皮肤/软组织占 10.2%，肺炎占 6.4%，血管内占 6.6%。8 例（2.0%）患儿在 30 天内因金黄色葡萄球菌菌血症死亡，15 例（3.5%）在 30 天内复发，38 例（9.6%）发生并发症，包括脓毒性栓子或感染的转移性病灶。耐甲氧西林与并发症的发生相关（优势比 3.31；95%可信区间 1.60-6.85），而导管相关性感染不太可能与并发症相关（优势比 0.40；95%可信区间 0.15-1.03）。在对菌血症持续时间的泊松回归分析中，耐甲氧西林、肌肉骨骼感染、血管内感染、黑种人以及源控制的延迟干预与菌血症持续时间较长显著相关。
在本队列中，MRSA 感染与菌血症持续时间较长和并发症发生的可能性较高相关。
