Daniel Engelman1, Alexandra Hofer2, Joshua S Davis3, Jonathan R Carapetis4, Robert W Baird2, Philip M Giffard5, Deborah C Holt5, Steven Y C Tong3. 1. Royal Darwin Hospital, Darwin, Australia; Centre for International Child Health, University of Melbourne, Australia; 2. Royal Darwin Hospital, Darwin, Australia; 3. Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia; 4. Menzies School of Health Research, Darwin, Australia; Telethon Institute for Child Health Research, University of Western Australia, Perth. 5. Menzies School of Health Research, Darwin, Australia;
Abstract
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 ISA was 27.9 cases per 100 000 population. Among pediatric cases, the annual incidence was 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 infections were predominantly community-associated (86%). Clinical infection sites included osteoarticular (66%), pleuropulmonary (29%), and endocarditis (9%), and multifocal disease was 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). Compared with methicillin-sensitive S aureus (MSSA), there was no difference in severity or presentation in pediatric MRSA cases, but a higher proportion of MRSA 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.
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 ISA was 27.9 cases per 100 000 population. Among pediatric cases, the annual incidence was 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 infections were predominantly community-associated (86%). Clinical infection sites included osteoarticular (66%), pleuropulmonary (29%), and endocarditis (9%), and multifocal disease was 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). Compared with methicillin-sensitive S aureus (MSSA), there was no difference in severity or presentation in pediatric MRSA cases, but a higher proportion of MRSA 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.
Authors: Asha C Bowen; Jonathan R Carapetis; Bart J Currie; Vance Fowler; Henry F Chambers; Steven Y C Tong Journal: Open Forum Infect Dis Date: 2017-11-02 Impact factor: 3.835
Authors: Marianne J Mullane; Timothy C Barnett; Jeffrey W Cannon; Jonathan R Carapetis; Ray Christophers; Juli Coffin; Mark A Jones; Julie A Marsh; Frieda Mc Loughlin; Vicki O'Donnell; Rebecca Pavlos; Bec Smith; Andrew C Steer; Steven Y C Tong; Roz Walker; Asha C Bowen Journal: BMJ Open Date: 2019-09-24 Impact factor: 2.692