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[Community-acquired Staphylococcus aureus bacteremia in children: analysis of mortality risk factors]
H R Paganini1, F González, L Casimir
1Servicio de Control Epidemiológico e Infectología, Hospital de Pediatria, Buenos Aires.
Insights
Community-acquired Staphylococcus aureus bacteremia (SaCB) in children frequently involves underlying conditions and skin/bone infections. Arterial hypotension, leucopenia, and non-hematologic diseases significantly increase SaCB mortality risk.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Clinical Microbiology
Context:
- Community-acquired Staphylococcus aureus bacteremia (SaCB) presents a significant challenge in pediatric populations.
- Understanding the epidemiology and risk factors for SaCB is crucial for effective management.
Purpose:
- To prospectively analyze episodes of pediatric SaCB, identifying primary infection sites, metastatic complications, and mortality predictors.
Summary:
- This study analyzed 60 SaCB episodes in children (mean age 78 months) from 1990-1994.
- Underlying diseases (e.g., acute lymphoblastic leukemia) were common (55%). Primary infection sites included skin and osteoarticular foci.
- Penicillin resistance was high (92%), but methicillin resistance was low (2 strains). Metastatic foci occurred in 40%, predominantly osteoarticular.
- Mortality was 20%. Multivariate analysis identified arterial hypotension (RR=24.8), leucopenia (RR=10.3), and non-hematologic diseases (RR=10.0) as significant predictors of mortality.
Impact:
- Findings highlight key risk factors for mortality in pediatric SaCB, including hypotension and specific comorbidities.
- The high rate of penicillin resistance underscores the need for appropriate antibiotic selection.
- This data informs clinical decision-making and resource allocation for managing pediatric S. aureus bacteremia.
Abstract:
Sixty episodes of community-acquired Staphylococcus aureus bacteremia (SaCB) were prospectively analyzed between January 1990 and December 1994. The mean age of the patients was 78 (1-180) months. Thirteen (55%) of the children had underlying disease, the most frequent one being acute lymphoblastic leukemia. In 83% of the episodes a primary site of infection was observed. Skin and osteoarticular foci were the most frequently encountered. Only two patients had endocarditis. Arterial hypotension was detected in 17% of the patients. Ninety two percent of S. aureus isolated were penicillin-resistant. Only two strains were methicillin-resistant. In 24 (40%) episodes where metastatic foci were detected, osteoarticular infections were predominant. Mortality due to SaCB was 20%. Multivariate analysis by logistic regression revealed that arterial hypotension (RR = 24.8; 4.77-128.9), leucopenia (RR = 10.3; 1.25-86.2) and non hemato-oncologic diseases (RR = 10.0; 1.09-92.2) correlated with high mortality rate (p = < 0.001).