TY - JOUR
T1 - Invasive Staphylococcus aureus Infections in Children in Tropical Northern Australia
AU - Engelman, Daniel
AU - Hofer, Alexandra
AU - Davis, Joshua
AU - Carapetis, Jonathan
AU - Baird, Robert
AU - Giffard, Philip
AU - Holt, Deborah
AU - Tong, Steven
PY - 2014
Y1 - 2014
N2 - Background. Despite a high burden of staphylococcal skin disease in children and high incidence of Staphylococcus aureus bacteremia in adult Indigenous populations in northern Australia, there are few studies describing incidence or clinical information of invasive S aureus (ISA) infections in children. Methods. We conducted a retrospective review for all cases of S aureus bacteremia and sterile site infections, for children under 15 years, in northern Australia over a 4-year period (2007-2010). Cases were categorized as neonatal (<28 days) and pediatric (≥28 days). Results. Forty-four cases (9 neonatal, 35 pediatric)were identified.The annual incidence of ISAwas 27.9 cases per 100 000 population. Among pediatric cases, the annual incidencewas significantly higher in the Indigenous (46.6) compared with the non-Indigenous (4.4) population (IRR: 10.6 [95%confidence interval, 3.8-41.4]). Pediatric infectionswere predominantly community-associated (86%).Clinical infection sites included osteoarticular (66%), pleuropulmonary (29%), and endocarditis (9%), and multifocal diseasewas common (20%). Eighty-three percent of pediatric cases presented with sepsis; 34%resulted in intensive care admission. Neonatal cases were all born prematurely; 89%were late-onset infections. Overall, 27%of infections were due to methicillin-resistant S aureus (MRSA).Comparedwithmethicillin-sensitive S aureus(MSSA), therewasnodifference in severityorpresentation in pediatricMRSA cases, but a higher proportion ofMRSA cases were readmitted. Conclusions. The annual incidence of ISA infection in this study is among the highest described, largely due to a disproportionate burden in Indigenous children. Infections are frequently severe and infection with MRSA is common. Children presenting with suspected ISA in this region should be treated empirically for MRSA.
AB - Background. Despite a high burden of staphylococcal skin disease in children and high incidence of Staphylococcus aureus bacteremia in adult Indigenous populations in northern Australia, there are few studies describing incidence or clinical information of invasive S aureus (ISA) infections in children. Methods. We conducted a retrospective review for all cases of S aureus bacteremia and sterile site infections, for children under 15 years, in northern Australia over a 4-year period (2007-2010). Cases were categorized as neonatal (<28 days) and pediatric (≥28 days). Results. Forty-four cases (9 neonatal, 35 pediatric)were identified.The annual incidence of ISAwas 27.9 cases per 100 000 population. Among pediatric cases, the annual incidencewas significantly higher in the Indigenous (46.6) compared with the non-Indigenous (4.4) population (IRR: 10.6 [95%confidence interval, 3.8-41.4]). Pediatric infectionswere predominantly community-associated (86%).Clinical infection sites included osteoarticular (66%), pleuropulmonary (29%), and endocarditis (9%), and multifocal diseasewas common (20%). Eighty-three percent of pediatric cases presented with sepsis; 34%resulted in intensive care admission. Neonatal cases were all born prematurely; 89%were late-onset infections. Overall, 27%of infections were due to methicillin-resistant S aureus (MRSA).Comparedwithmethicillin-sensitive S aureus(MSSA), therewasnodifference in severityorpresentation in pediatricMRSA cases, but a higher proportion ofMRSA cases were readmitted. Conclusions. The annual incidence of ISA infection in this study is among the highest described, largely due to a disproportionate burden in Indigenous children. Infections are frequently severe and infection with MRSA is common. Children presenting with suspected ISA in this region should be treated empirically for MRSA.
KW - Bacteremia
KW - Indigenous
KW - Neonatal
KW - Pediatric
KW - Staphylococcus aureus
UR - http://www.scopus.com/inward/record.url?scp=84949128001&partnerID=8YFLogxK
U2 - 10.1093/jpids/piu013
DO - 10.1093/jpids/piu013
M3 - Article
VL - 3
SP - 304
EP - 311
JO - Journal of the Pediatric Infectious Diseases Society
JF - Journal of the Pediatric Infectious Diseases Society
SN - 2048-7193
IS - 4
ER -