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Published on: February 9, 2011
Staphylococcus aureus Bacteremia in the Pediatric Emergency Department and Predictors of Poor Outcome
María Suárez-Bustamante Huélamo1, José Antonio Alonso-Cadenas1, Borja Gómez Cortés2
1From the Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Insights
Staphylococcus aureus bacteremia (SAB) in children often affects previously healthy individuals with focal infections. C-reactive protein is the sole identified predictor of poor outcomes in pediatric SAB cases.
Area of Science:
- Pediatric Infectious Diseases
- Bacteremia Research
- Clinical Microbiology
Background:
- Staphylococcus aureus bacteremia (SAB) is a significant cause of bloodstream infections in children.
- Previously healthy children over 5 years old are increasingly affected by SAB.
- Understanding SAB presentation and outcomes in pediatric emergency settings is crucial.
Purpose of the Study:
- To describe infants diagnosed with SAB in pediatric emergency departments.
- To identify clinical and laboratory predictors of poor outcomes in pediatric SAB.
- To analyze risk factors associated with SAB in children.
Main Methods:
- Observational study with subanalysis of a multicenter prospective registry (2011-2016).
- Included patients under 18 years with positive blood cultures from 22 Spanish pediatric emergency departments.
- Risk factors for SAB included chronic diseases, immunosuppressive treatment, and mechanical devices.
Main Results:
- 229 patients with SAB; 76.9% were previously healthy, 69.0% had focal infections.
- 13.5% experienced poor outcomes (including 4 deaths).
- Poor outcomes linked to SAB risk factors, abnormal pediatric assessment triangle, elevated procalcitonin, and C-reactive protein (CRP). CRP was the only independent predictor.
Conclusions:
- Pediatric SAB often occurs in previously healthy children with focal infections.
- Approximately 1 in 7 children with SAB experience poor outcomes.
- C-reactive protein is the primary identified predictor of poor outcomes in pediatric SAB.
Background:
Staphylococcus aureus has become the leading cause of bacteremia among previously healthy children older than 5 years.
Methods:
We aimed to describe the infants presenting to pediatric emergency departments and diagnosed with S. aureus bacteremia (SAB) and identify predictors (clinical and laboratory variables) of poor outcome (complications, sequelae or death). We performed an observational study and subanalysis of a multicenter prospective registry, including every patient under the age of 18 years with a positive blood culture obtained at any of the 22 participating Spanish pediatric emergency departments between 2011 and 2016. We considered chronic diseases, immunosuppressive treatment and the presence of mechanical devices as risk factors for SAB.
Results:
Of the 229 patients with SAB, 176 (76.9%) were previously healthy, 192 (83.8%) had a normal pediatric assessment triangle and 158 (69.0%) had an associated focal infection (mainly osteoarticular infection, skin and soft tissue infection and pneumonia). Fifty-three patients (23.1%) had 1 or more risk factors for SAB. Thirty-one (13.5%) presented a poor outcome, including 4 deaths (1.7%). A poor outcome was more common in patients with SAB risk factors [odds ratio (OR): 7.0; 95% CI: 3.2-15.4], abnormal PAT (OR: 5.9; 95% CI: 2.6-13.3), elevated procalcitonin (OR: 1.2; 95% CI: 1.05-1.3) and C-reactive protein, the latter being the only independent predictor of poor outcome (OR: 1.01; 95% CI: 1.01-1.02).
Conclusions:
Overall, children with SAB are previously healthy, appear well, and have an associated focal infection. One of 7 had a poor outcome, with C-reactive protein being the only predictor identified.
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