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Published on: November 4, 2016
Community-acquired invasive Staphylococcus aureus: Uncovering disparities and the burden of disease in Auckland
Alison M Vogel1,2, Annie Borland1,3, Bert van der Werf4
1Department of Paediatrics, University of Auckland, Auckland, New Zealand.
Insights
Invasive Staphylococcus aureus (iSA) disease in children is underestimated by focusing solely on bacteraemia. Pacific infants face the highest risk, highlighting significant ethnic and socioeconomic disparities in pediatric iSA.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Staphylococcus aureus (SA) is a significant cause of invasive disease in children.
- Existing research often focuses on SA bacteraemia, potentially underestimating the total burden of community-acquired invasive SA (iSA).
- Limited data exists on the comprehensive incidence and risk factors of iSA in pediatric populations.
Purpose of the Study:
- To determine the total burden of community-acquired invasive Staphylococcus aureus (iSA) in children aged 0-14 years in Auckland.
- To identify ethnic and socioeconomic disparities in iSA incidence and outcomes.
- To analyze risk factors associated with severe iSA, including intensive care unit admission and mortality.
Main Methods:
- Retrospective, cross-sectional analysis of hospitalized children (0-14 years) with iSA from 2011-2015.
- Utilized laboratory databases and ICD-10 discharge codes to identify community-onset iSA cases.
- Reviewed clinical records and coroner's reports to confirm iSA, determine clinical syndromes, and exclude nosocomial infections.
Main Results:
- 295 children diagnosed with iSA; annual incidence of 18.6 per 100,000.
- Significantly higher incidence in Pacific (44.3/100,000) and Māori (24.3/100,000) populations compared to NZ European/other (8.8/100,000).
- Pacific infants had 10x higher iSA incidence than non-Māori/non-Pacific infants; high deprivation areas, male sex, and Pacific ethnicity were associated with increased risk. ICU admission risk was elevated for infants, Pacific children, and those with respiratory, multifocal, or endovascular infections. Seven deaths occurred, primarily in infants with respiratory infections.
Conclusions:
- Focusing solely on Staphylococcus aureus bacteraemia underestimates the true burden of invasive SA (iSA) disease in children.
- Significant ethnic and socioeconomic disparities exist in pediatric iSA, with Pacific infants being the most vulnerable population.
- Interventions targeting high-risk groups and addressing socioeconomic determinants are crucial for reducing iSA burden.
Aim:
Staphylococcus aureus (SA) causes serious invasive disease in children. Large studies have measured the incidence of SA bacteraemia, but there is less information on the total burden of community-acquired invasive SA (iSA) in children.
Methods:
A retrospective, cross-sectional analysis of Auckland resident children aged 0-14 years who were hospitalised with iSA between 2011 and 2015 was performed. Laboratory databases and SA-related international classification of diseases 10 discharge codes were searched to identify community-onset cases with SA isolated from a normally sterile site. Clinical records and coroner's reports were reviewed to determine clinical syndromes and exclude nosocomial infections.
Results:
A total of 295 children with iSA were identified. The average annual incidence of iSA was 18.6 per 100 000 - for Pacific populations 44.3 per 100 000, Māori 24.3 per 100 000 and New Zealand European and other 8.8 per 100 000; 68% had bacteraemia. The incidence of iSA for Pacific infants was 10 times greater than non-Māori/non-Pacific (113.4/100 000 population vs. 11.8/100 000). Multivariate analysis found a higher risk of admission in Pacific children, males and those living in areas of high deprivation. Thirty-two patients (10.8%) were admitted to the intensive care unit; risk was higher in infants, Pacific children and those with respiratory infection (Relative Risk (RR) 12.2, 95% confidence interval (CI) 5.7-26.4) and multifocal (RR 6.9, 95% CI 3.4-13.8) and endovascular disease (RR 8.9, 95% CI 3.9-20.6). All deaths (n = 7) had respiratory infections, and four were patients <1 year of age.
Conclusions:
Studies investigating SA bacteraemia alone significantly underestimate the total burden of iSA disease. There are marked ethnic and socio-economic disparities in iSA disease among Auckland children. Pacific infants are at the highest risk.
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