Clinical and molecular epidemiology of Staphylococcus aureus catheter-related bacteremia in children

Pediatr Infect Dis J. 2010 May;29(5):410-4. doi: 10.1097/INF.0b013e3181c767b6.

Abstract

Background: Staphylococcus aureus (SA) is an important cause of catheter-related bacteremia (CRB). The USA300 clone increasingly causes healthcare associated infections. We compared children with SA-CRB due to USA300 versus non-USA300 isolates and identified risk factors for complications.

Methods: Children at Texas Children's Hospital (TCH) with SA-CRB were identified from a prospective S. aureus surveillance study. S. aureus isolates were characterized by methicillin susceptibility and pulsed field gel electrophoresis.

Results: From August 2001 to October 2007, 112 children with a first episode of SA-CRB and corresponding isolates were identified. USA300 accounted for 21 isolates. Metastatic infection complicated 10.7% of cases and was associated with methicillin resistance. Other complications were recurrence (n = 16), death (n = 13), thrombosis (n = 9), and intravascular "cast" (n = 6). Four patients with non-USA300 SA-CRB had endocarditis. Prolonged bacteremia was more common in methicillin-resistant SA (12/29) than in methicillin-susceptible SA SA-CRB (14/83) (P = 0.007). Complications were more common in patients with bacteremia > or =4 days (16/26 [61.5%]) versus patients with bacteremia <4 days (25/86 [29%]) (P = 0.003). The complication rate was lower in patients who had the catheter removed <4 days (22.5%) versus patients whose catheter was removed > or =4 days after infection or not removed (44.4%) (P = 0.02). Children with USA300 versus non-USA300 isolates did not differ with respect to frequency or type of complications.

Conclusions: At Texas Children's Hospital, the USA300 clone caused 19% of initial SA-CRB episodes and was associated with methicillin resistance. Complications occurred in 36.6% of the patients and were associated with prolonged bacteremia and catheter removal > or =4 days after infection or failure to remove the catheter.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Bacteremia / epidemiology*
  • Bacteremia / microbiology
  • Bacterial Typing Techniques
  • Catheter-Related Infections / epidemiology*
  • Catheter-Related Infections / microbiology
  • Child
  • Child, Preschool
  • Cluster Analysis
  • DNA Fingerprinting
  • DNA, Bacterial / genetics
  • Electrophoresis, Gel, Pulsed-Field
  • Female
  • Genotype
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Methicillin / pharmacology
  • Methicillin Resistance
  • Microbial Sensitivity Tests
  • Molecular Epidemiology
  • Prospective Studies
  • Staphylococcal Infections / epidemiology*
  • Staphylococcal Infections / microbiology
  • Staphylococcus aureus / classification*
  • Staphylococcus aureus / genetics*
  • Staphylococcus aureus / isolation & purification
  • Texas

Substances

  • Anti-Bacterial Agents
  • DNA, Bacterial
  • Methicillin