Staphylococcus aureus (SA) is a major cause of bacteremia in children. Methicillin-resistant SA (MRSA), poses a public health threat, however, mortality among Israeli children suffering MSSA vs. MRSA bacteremia is unknown.
We collected all SA bacteremia events in children (0-16 years), from 2002 to 2016, in Hadassah medical center. Positive cultures within 48 hours of hospitalization were considered community associated (CA). Those obtained afterwards or from children hospitalized within the previous year, were considered Health-care associated (HA).
We recorded 427 events, 284 (66%) were HA, 64 (15%) were MRSA and 9 (2%) were CA-MRSA. There was no increase in MRSA incidence during the study period. Overall 75 (17.5%) children died, during a follow-up of 3475 patient years (54 MSSA and 21 MRSA). In-hospital and 30 days mortality were 3% and 3.5%, respectively (12 and 16 cases). Controlling for age, sex and ethnicity, HA-MSSA and HA-MRSA were both associated with increased 1-year mortality: Hazard ratio (HR) (95% Confidence interval {CI}) - 4.9 (1.7-14) and 10.5 (3.4-33), respectively. Interestingly, among 1-year survivors, long term mortality was still associated with these factors: HR (95%CI) - 5.6 (1.3-25) and 13 (3-66), respectively.
This study demonstrates the high burden of MSSA bacteremia in hospitalized children. The short- and long-term risk for all-cause mortality is significantly high for HA-MSSA and more so for HA-MRSA bacteremia, when compared to CA bacteremia. The very low rate of CA-MRSA bacteremia justifies the current practice not to include Glycopeptides in the empiric treatment of CA bacteremia.
