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Updated: Mar 1, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Epidemiology of Methicillin-Resistant Staphylococcus aureus Bacteremia in Children
Rana F Hamdy1, Alice J Hsu2, Chris Stockmann3
1Department of Pediatrics, Children's National Health System, Washington, DC; rhamdy@childrensnational.org.
Background:
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with high rates of treatment failure in adults. The epidemiology, clinical outcomes, and risk factors for treatment failure associated with MRSA bacteremia in children are poorly understood.
Methods:
Multicenter, retrospective cohort study of children ≤18 years hospitalized with MRSA bacteremia across 3 tertiary care children's hospitals from 2007 to 2014. Treatment failure was defined as persistent bacteremia >3 days, recurrence of bacteremia within 30 days, or attributable 30-day mortality. Potential risk factors for treatment failure, including the site of infection, vancomycin trough concentration, critical illness, and need for source control, were collected via manual chart review and evaluated using multivariable logistic regression.
Results:
Of 232 episodes of MRSA bacteremia, 72 (31%) experienced treatment failure and 23% developed complications, whereas 5 (2%) died within 30 days. Multivariable analysis of 174 children treated with vancomycin with steady-state vancomycin concentrations obtained found that catheter-related infections (odds ratio [OR], 0.36; 95% confidence interval [CI]: 0.13-0.94) and endovascular infections (OR, 4.35; 95% CI: 1.07-17.7) were associated with lower and higher odds of treatment failure, respectively, whereas a first vancomycin serum trough concentration <10 μg/mL was not associated with treatment failure (OR, 1.34; 95% CI, 0.49-3.66). Each additional day of bacteremia was associated with a 50% (95% CI: 26%-79%) increased odds of bacteremia-related complications.
Conclusions:
Hospitalized children with MRSA bacteremia frequently suffered treatment failure and complications, but mortality was low. The odds of bacteremia-related complications increased with each additional day of bacteremia, emphasizing the importance of achieving rapid sterilization.
Insights
Pediatric methicillin-resistant Staphylococcus aureus (MRSA) bacteremia often leads to treatment failure and complications, though mortality is low. Rapid sterilization is crucial, as prolonged bacteremia increases complication risks in children.
Area of Science:
- Pediatric Infectious Diseases
- Bacteremia Management
- Antimicrobial Resistance
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is a significant concern in adults, with high treatment failure rates.
- Limited understanding exists regarding the epidemiology, clinical outcomes, and risk factors for treatment failure in pediatric MRSA bacteremia.
Purpose of the Study:
- To investigate the epidemiology, clinical outcomes, and risk factors for treatment failure in children hospitalized with MRSA bacteremia.
- To identify factors associated with treatment failure and complications in pediatric MRSA bacteremia.
Main Methods:
- A multicenter, retrospective cohort study involving children (≤18 years) with MRSA bacteremia from 2007-2014.
- Treatment failure defined by persistent bacteremia, recurrence, or 30-day attributable mortality.
- Multivariable logistic regression analyzed risk factors including infection site and vancomycin trough concentrations.
Main Results:
- 31% of 232 MRSA bacteremia episodes resulted in treatment failure; 23% developed complications, and 2% died within 30 days.
- Catheter-related infections were linked to lower treatment failure odds (OR 0.36), while endovascular infections increased odds (OR 4.35).
- Each additional day of bacteremia significantly increased the odds of complications (50% increase per day).
Conclusions:
- Hospitalized children with MRSA bacteremia frequently experience treatment failure and complications, despite low mortality rates.
- Achieving rapid clearance of bacteremia is critical to reduce the risk of complications.
- Further research may elucidate optimal treatment strategies for pediatric MRSA bacteremia.
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