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Higher risk of complications for children with MRSA despite lower mortality rate
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Although mortality rates were lower for children with methicillin-resistant Staphylococcus aureus compared with adults, children experienced more frequent treatment failure and complications, with the chances of bacteremia-related complications increasing 50% for every additional day of infection, according to a study published in Pediatrics.
“Knowing that the risk of complications increases with every additional day the bacteria are detected in the bloodstream highlights the importance of early and aggressive therapy for these infections,” Rana F. Hamdy, MD, MPH, MSCE, attending physician in the Division of Infectious Diseases and director of the Antimicrobial Stewardship Program at Children’s National Health System, said in a press release.
To describe the clinical epidemiology of MRSA bacteremia in pediatric patients alongside their risk factors for treatment failure in this demographic, the researchers conducted a multicenter, retrospective cohort study that included patients aged 18 years or younger. Each patient presented with MRSA bacteremia between 2007 and 2014 at three tertiary children’s hospitals.
Those who experienced treatment failure had persistent bacteremia for more than 3 days, recurrence within 30 days or mortality within 30 days attributed to MRSA infection. Site of infection, vancomycin trough concentration, critical illness and a need for source control were considered to be risk factors in this cohort. Data concerning these factors were gathered through manual chart review and assessed using multivariable logistic regression.
MRSA bacteremia contributed to 232 observed episodes, with 31% of patients experiencing treatment failure and 23% developed complications. Five children in this cohort (2%) died within 30 days. For children treated with steady-state vancomycin concentrations, infections associated with catheter use were linked to lower chances of treatment failure. In this group, the initial vancomycin serum concentration was not linked with treatment failure. However, investigators found endovascular infection was linked with treatment failure. For every day in which infection was found, there was an added 50% increase in the odds of a complication.
“This was the first step, but additional data are needed,” Hamdy said in the release. “Future studies should pinpoint exact concentrations of vancomycin we should achieve in children so that the medicine clears infections effectively without causing additional harm.”— by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures.
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