Shannon L Carpenter1, Jennifer Goldman2, Ashley K Sherman3, J Jeremiah Bell4, Suresh Selveraju4, Jason G Newland2, Dale E Jarka5, Katherine Chastain6, Rangaraj Selvarangan7. 1. Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States; Division of Pediatric Hematology/Oncology/BMT, Children's Mercy Hospital, Kansas City, MO, United States. Electronic address: slcarpenter@cmh.edu. 2. Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States; Division of Pediatric Infectious Diseases, Children's Mercy Hospital, Kansas City, MO, United States. 3. Department of Research Development and Clinical Investigation, Children's Mercy Hospital, Kansas City, MO, United States. 4. Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, United States. 5. Department of Orthopedic Surgery, Children's Mercy Hospital, Kansas City, MO, United States. 6. Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States; Division of Pediatric Hematology/Oncology/BMT, Children's Mercy Hospital, Kansas City, MO, United States. 7. Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States; Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, United States.
Abstract
OBJECTIVES: Children with Staphylococcus aureus (SA) bacteremia risk developing venous thromboembolism (VTE). We sought to identify clinical variables and bacterial virulence factors associated with VTE in SA bacteremia. STUDY DESIGN: This is a single-institution retrospective study of 229 children with SA bacteremia hospitalized from 2005 to 2008. Clinical data were abstracted from patient charts. Two-hundred three SA isolates were analyzed by polymerase chain reaction. The Pediatric Health Information System (PHIS) database was queried to identify subjects with a central venous line (CVL) or complex chronic conditions (CCC). Logistic regression analysis was employed to determine which factors most greatly influenced VTE. RESULTS: VTE was present in 9.2% (n=21/229). Superficial thrombi were excluded. Mortality was greater in patients with VTE [24% vs. 6% (p=0.016)]. Among SA isolates available for virulence testing, the majority (70%; n=139) were methicillin-sensitive SA (MSSA). Methicillin-resistant SA (MRSA) infection was associated with VTE (p=0.01). The most common sites of thrombosis were extremity deep vein (58%; n=14/24), head/neck (29%; n=7), and visceral (13%; n=3). One subject had a pulmonary embolism. The presence of a CVL or a CCC was not associated with VTE. Independent predictors of VTE were C-reactive protein (CRP)≥20mg/dl [OR 4.2, 95% CI 1.16-15.25] and hemoglobin nadir ≤9g/dl [OR 5.2, 95% CI 1.3-20.64]. CONCLUSIONS: In addition to MRSA infection, CRP≥20mg/dl and hemoglobin nadir ≤9g/dl were associated with VTE in SA bacteremia. These factors may serve as markers for increased risk of VTE with invasive SA disease.
OBJECTIVES:Children with Staphylococcus aureus (SA) bacteremia risk developing venous thromboembolism (VTE). We sought to identify clinical variables and bacterial virulence factors associated with VTE in SAbacteremia. STUDY DESIGN: This is a single-institution retrospective study of 229 children with SAbacteremia hospitalized from 2005 to 2008. Clinical data were abstracted from patient charts. Two-hundred three SA isolates were analyzed by polymerase chain reaction. The Pediatric Health Information System (PHIS) database was queried to identify subjects with a central venous line (CVL) or complex chronic conditions (CCC). Logistic regression analysis was employed to determine which factors most greatly influenced VTE. RESULTS:VTE was present in 9.2% (n=21/229). Superficial thrombi were excluded. Mortality was greater in patients with VTE [24% vs. 6% (p=0.016)]. Among SA isolates available for virulence testing, the majority (70%; n=139) were methicillin-sensitive SA (MSSA). Methicillin-resistant SA (MRSA) infection was associated with VTE (p=0.01). The most common sites of thrombosis were extremity deep vein (58%; n=14/24), head/neck (29%; n=7), and visceral (13%; n=3). One subject had a pulmonary embolism. The presence of a CVL or a CCC was not associated with VTE. Independent predictors of VTE were C-reactive protein (CRP)≥20mg/dl [OR 4.2, 95% CI 1.16-15.25] and hemoglobin nadir ≤9g/dl [OR 5.2, 95% CI 1.3-20.64]. CONCLUSIONS: In addition to MRSA infection, CRP≥20mg/dl and hemoglobin nadir ≤9g/dl were associated with VTE in SAbacteremia. These factors may serve as markers for increased risk of VTE with invasive SA disease.
Authors: James D Fortenberry; Trung Nguyen; Jocelyn R Grunwell; Rajesh K Aneja; Derek Wheeler; Mark Hall; Geoffrey Fleming; Rod Tarrago; Sandra Buttram; Heidi Dalton; Yong Han; Kirk A Easley; Andrea Knezevic; Tian Dai; Matthew Paden; Joseph A Carcillo Journal: Crit Care Med Date: 2019-03 Impact factor: 7.598
Authors: Martine A Aardoom; Renz C W Klomberg; Polychronis Kemos; Frank M Ruemmele; C H Heleen van Ommen; Lissy de Ridder; Nicholas M Croft Journal: J Crohns Colitis Date: 2022-06-24 Impact factor: 10.020