Invasive Staphylococcus aureus infections in children in tropical northern Australia

Abstract

Background. Despite a high burden of staphylococcal skin disease in children and high incidence of Staphylococcus aureus bacteremia in adult Indigenous populations in northern Australia, there are few studies describing incidence or clinical information of invasive S aureus (ISA) infections in children. Methods. We conducted a retrospective review for all cases of S aureus bacteremia and sterile site infections, for children under 15 years, in northern Australia over a 4-year period (2007-2010). Cases were categorized as neonatal (<28 days) and pediatric (≥28 days). Results. Forty-four cases (9 neonatal, 35 pediatric)were identified.The annual incidence of ISAwas 27.9 cases per 100 000 population. Among pediatric cases, the annual incidencewas significantly higher in the Indigenous (46.6) compared with the non-Indigenous (4.4) population (IRR: 10.6 [95%confidence interval, 3.8-41.4]). Pediatric infectionswere predominantly community-associated (86%).Clinical infection sites included osteoarticular (66%), pleuropulmonary (29%), and endocarditis (9%), and multifocal diseasewas common (20%). Eighty-three percent of pediatric cases presented with sepsis; 34%resulted in intensive care admission. Neonatal cases were all born prematurely; 89%were late-onset infections. Overall, 27%of infections were due to methicillin-resistant S aureus (MRSA).Comparedwithmethicillin-sensitive S aureus(MSSA), therewasnodifference in severityorpresentation in pediatricMRSA cases, but a higher proportion ofMRSA cases were readmitted. Conclusions. The annual incidence of ISA infection in this study is among the highest described, largely due to a disproportionate burden in Indigenous children. Infections are frequently severe and infection with MRSA is common. Children presenting with suspected ISA in this region should be treated empirically for MRSA.