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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Invasive Staphylococcus aureus Infections in Children in Tropical Northern Australia
Daniel Engelman1, Alexandra Hofer2, Joshua S Davis3
1Royal Darwin Hospital, Darwin, Australia; Centre for International Child Health, University of Melbourne, Australia;
Insights
Invasive Staphylococcus aureus infections are high in northern Australian children, especially Indigenous children. Empirical treatment for methicillin-resistant S aureus (MRSA) is recommended due to commonality and severity.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Public Health Epidemiology
Background:
- High burden of staphylococcal skin disease in children and S. aureus bacteremia in Indigenous adults in northern Australia.
- Limited data on invasive S. aureus (ISA) infections in pediatric populations in this region.
- Need for understanding ISA epidemiology in children in northern Australia.
Purpose of the Study:
- To determine the incidence and clinical characteristics of invasive S. aureus infections in children under 15 years in northern Australia.
- To compare ISA incidence between Indigenous and non-Indigenous children.
- To identify risk factors and outcomes associated with ISA in children.
Main Methods:
- Retrospective review of S. aureus bacteremia and sterile site infections in children (<15 years) from 2007-2010.
- Categorization of cases into neonatal (<28 days) and pediatric (≥28 days).
- Calculation of annual incidence rates and comparison between Indigenous and non-Indigenous populations.
Main Results:
- Forty-four cases identified; overall ISA incidence was 27.9 per 100,000 population.
- Significantly higher incidence in Indigenous pediatric cases (46.6) vs. non-Indigenous (4.4).
- Predominantly community-associated infections (86%), common sites included osteoarticular (66%) and pleuropulmonary (29%); 27% were MRSA.
Conclusions:
- Northern Australia has one of the highest described ISA infection rates, disproportionately affecting Indigenous children.
- ISA infections in children are often severe, with high rates of sepsis and intensive care admission.
- Empirical treatment for MRSA is advised for children with suspected ISA in this region.
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 ISA was 27.9 cases per 100 000 population. Among pediatric cases, the annual incidence was 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 infections were predominantly community-associated (86%). Clinical infection sites included osteoarticular (66%), pleuropulmonary (29%), and endocarditis (9%), and multifocal disease was 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). Compared with methicillin-sensitive S aureus (MSSA), there was no difference in severity or presentation in pediatric MRSA cases, but a higher proportion of MRSA 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.
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