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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Frequency and risk factors for deep focus of infection in children with Staphylococcus aureus bacteremia
Allison C Ross1, Philip Toltzis, Mary Ann O'Riordan
1Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. acrst16@hotmail.com
Insights
Deep-seated infections from Staphylococcus aureus bacteremia (SAB) in children are usually apparent upon diagnosis. Unsuspected deep infections are rare and occur in specific pediatric patient groups.
Area of Science:
- Pediatric Infectious Diseases
- Bacteremia Management
- Diagnostic Imaging in Children
Background:
- Staphylococcus aureus bacteremia (SAB) in children can lead to deep-seated infections, necessitating extensive diagnostic evaluations.
- Identifying the frequency and risk factors for these deep foci is crucial for optimizing patient care.
Purpose of the Study:
- To determine the occurrence of deep-seated infections in pediatric patients with SAB.
- To identify risk factors associated with deep foci of infection in children experiencing SAB.
Main Methods:
- Retrospective review of medical charts for children admitted with SAB between January 1992 and June 2006.
- Deep infection foci were confirmed via echocardiogram, bone imaging, or abdominal imaging.
Main Results:
- Of 298 children studied, 16% had clinically apparent deep infection foci confirmed by imaging.
- 3.7% had clinically unsuspected deep foci, often associated with underlying conditions or central venous catheters.
- Prolonged positive blood cultures (>1 day) were linked to unsuspected deep infections (P < 0.01). Endocarditis was rare (2.7%).
Conclusions:
- Deep-seated infections in pediatric SAB are typically evident at the time of bacteremia diagnosis.
- Clinically unsuspected deep infections are uncommon and primarily affect specific pediatric patient populations.
- Routine diagnostic imaging for all children with SAB is not universally indicated.
Background:
Staphylococcus aureus bacteremia (SAB) in children may be associated with development of deep-seated foci of infection, often prompting extensive diagnostic testing. The objective of this study was to establish the frequency and risk factors for deep foci of infection from SAB in pediatric patients.
Methods:
Medical charts of all children admitted with SAB to a tertiary-care center from January 1992 to June 2006 were reviewed. Study outcome was the presence of a deep focus of infection as documented by positive echocardiogram, bone imaging or abdominal imaging.
Results:
We studied 298 children, of whom 190 (64%) had echocardiograms, 116 (39%) had abdominal imaging, and 103 (35%) had bone imaging. Forty-seven subjects (16%) had symptoms of a deep focus of infection on discovery of SAB, which then was confirmed by 1 of the 3 tests. Eleven (3.7%) additional subjects had a clinically unsuspected deep focus identified before discharge. All children with an unsuspected deep focus of infection had either an underlying medical condition that potentially obscured the diagnosis or a central venous catheter. More than 1 day of positive blood cultures was associated with an unsuspected deep-seated infection (P < 0.01). Endocarditis was uncommon (2.7%), and occurred only in children with known congenital heart disease or with a central catheter.
Conclusions:
Deep-seated infections from SAB in children are most often clinically apparent at discovery of bacteremia. Unsuspected deep-seated infection is uncommon and confined to specific hosts. Routine diagnostic imaging is not indicated in all children with SAB.
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