0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Epidemiology and Mortality of Staphylococcus aureus Bacteremia in Australian and New Zealand Children ONLINE FIRST

Brendan J. McMullan, BMed (Hons)1,2; Asha Bowen, MBBS, PhD3,4,5,6; Christopher C. Blyth, MB, PhD3,4,6,7; Sebastiaan Van Hal, PhD8; Tony M. Korman, MBBS (Hons)9; Jim Buttery, MBBS10; Lesley Voss, MBChB11; Sally Roberts, MBBS12; Celia Cooper, BMBS13; Steven Y. C. Tong, MBBS (Hons), PhD5,14; John Turnidge, MBBS15,16,17,18
[+] Author Affiliations
1Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Randwick, New South Wales, Australia
2School of Women’s and Children’s Health, University of New South Wales, New South Wales, Australia
3Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
4Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
5Menzies School of Health Research, Darwin, Northern Territory, Australia
6School of Pediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia
7Department of Microbiology, Princess Margaret Hospital, PathWest Laboratory Medicine, Western Australia, Australia
8Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital Camperdown, Sydney, New South Wales, Australia
9Monash Infectious Diseases, Monash University, Monash Health, Victoria, Australia
10Department of Infection and Immunity, Monash Children’s Hospital, Department of Pediatrics, Monash University, Victoria, Australia
11Department of Pediatric Infectious Disease, Starship Children’s Hospital, Auckland, New Zealand
12Microbiology Department, LabPlus, Auckland Hospital, Auckland, New Zealand
13Department of Microbiology and Infectious Diseases, South Australia Pathology, Women's and Children’s Hospital, North Adelaide, South Australia, Australia
14Royal Darwin Hospital, Darwin, Northern Territory, Australia
15Department of Anatomy and Pathology, University of Adelaide, Adelaide, South Australia, Australia
16Department of Pediatrics, University of Adelaide, Adelaide, South Australia, Australia
17Department of Molecular and Cellular Biology, University of Adelaide, Adelaide, South Australia, Australia
18Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
JAMA Pediatr. Published online August 15, 2016. doi:10.1001/jamapediatrics.2016.1477
Text Size: A A A
Published online

Importance  Staphylococcus aureus bacteremia (SAB) in children causes significant morbidity and mortality, but the epidemiology in children is not well characterized.

Objective  To describe the epidemiology of SAB in children and adolescents younger than 18 years from Australia and New Zealand.

Design, Setting, and Participants  A prospective cohort study, using data from the Australian New Zealand Cooperative on Outcomes in Staphylococcal Sepsis cohort for 1153 children with SAB from birth to less than 18 years in pediatric and general hospitals across Australia and New Zealand, collected between January 1, 2007, and December 31, 2012. Multivariate analysis was performed to identify risk factors for mortality. Incidence calculations were calculated separately for Australasian children younger than 15 years using postcode population denominator data from Australian and New Zealand census data.

Main Outcomes and Measures  Demographic data, hospital length of stay, principal diagnosis, place of SAB onset (community or hospital), antibiotic susceptibility and principal antibiotic treatment, and 7- and 30-day mortality.

Results  Of the 1153 children with SAB, complete outcome data were available for 1073 children (93.1%); of these, males accounted for 684 episodes (63.7%) of SAB. The median age was 57 months (interquartile range, 2 months to 12 years). The annual incidence of SAB for Australian children was 8.3 per 100 000 population and was higher in indigenous children (incident rate ratio, 3.0 [95% CI, 2.4-3.7]), and the incidence for New Zealand children was 14.4 per 100 000 population and was higher in Māori children (incident rate ratio, 5.4 [95% CI, 4.1-7.0]). Community-onset SAB occurred in 761 cases (70.9%), and 142 cases (13.2%) of the infections were methicillin-resistant S aureus (MRSA). Bone or joint infection was most common with 348 cases (32.4%), and endocarditis was uncommon with 30 cases (2.8%). Seven- and 30-day mortality rates were 2.6% (n = 28) and 4.7% (n = 50), respectively. Risk factors for mortality were age younger than 1 year; Māori or Pacific ethnicity; endocarditis, pneumonia, or sepsis; and receiving no treatment or treatment with vancomycin. Mortality was 14.0% (6 of 43) in children with methicillin-susceptible S aureus (MSSA) treated with vancomycin compared with 2.6% (22 of 851) in children treated with alternative agents (OR, 6.1 [95% CI, 1.9-16.7]). MRSA infection was associated with increased length of stay but not mortality.

Conclusions and Relevance  In this large cohort study of the epidemiology of SAB in children, death was uncommon, but the incidence was higher for infants and varied by treatment, ethnicity, and clinical presentation. This study provides important information on the epidemiology of SAB in children and risk factors for mortality.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Susceptibility of Children to Staphylococcus aureus Bacteremia by Region

ACT indicates Australian Capital Territory; mrMRSA, multiresistant methicillin-resistant S aureus; MSSA, methicillin-susceptible S aureus; nmMRSA, nonmultiresistant methicillin-resistant S aureus; and NSW, New South Wales.

aIn the Northern Territory, 79 of 99 (79.8%) children were Australian Indigenous compared with fewer than 15% in all other Australian regions studied.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Survival by Age

SAB indicates Staphylococcus aureus bacteremia.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

339 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();