Predictors of Persistence Community Acquired Staphylococcus aureus Bacteremia in Children. Cohort Study

Abstract

Background. Community acquired Staphylococcus aureus bacteremia (SAB) is a frequent cause of hospitalization in children. Persistent bacteremia (more than 7 days) is associated with higher morbidity. The main objective of this study was to identify clinical predictors of persistent SAB. Methods. Prospective cohort study. January 2010-December 2016. Inclusion criteria: age>30 days and <16 years, hospitalized in a pediatric referral hospital with community acquired infections, with development of SA in blood cultures. Exclusion criteria: history of recent hospitalization, attendance at a health care center, living in a closed community, or venous catheter. Microbiological, demographic and clinical characteristics were compared in children when SAB lasted > or < 7 days. Bivariate and multivariate analysis was performed. Stata13 was used. Results. n 250. One hundred and sixteen (64%) were male. Median age was 60 months (IQR 22-131). Methicillin-resistant Staphylococcus aureus(MRSA) was identified in 163 patients (65%). Clindamycin resistance was identified in 21 cases (8%). Median length of SAB was 3 days (IQR 2-4). In twenty-six patients (11%) SAB lasted 7 or more days. In bivariate analysis, pneumonia (OR 4.6, 95% CI 2-10.6, P < 0.001), sepsis at admission (OR 3.8 95% CI 1.6-8.7, p 0.002), intensive care unit admission (OR 2.9 95% CI 1.3-7, P < 0.01), delayed drainage (OR 4.7, 95% CI 1.4-16, p: 0.01) and MRSA (OR 7.4, 95% CI 1.7-31, p 0.01) were associated with prolonged SAB. No association with age, sex, site of infection, Vancomycin or Clindamycin empiric treatment was found. In multivariate logistic model, MRSA (OR 5.9 95% CI 1.4-25.9 p: 0.02) and sepsis at admission day (OR 2.9, 95% CI 1.3-2.5, p: 0.01) were predictors of SAB duration more than 7 days. Conclusion. In this study of Community Acquired SAB, MRSA was prevalent. Methicillin-resistance and sepsis at admission day were identified as predictors of SAB persistence (more than 7 days).