Staphylococcus aureus bacteremia in hospitalized children under 3 months of age.

Ramselaar, H.J.T. (Henrietta) (2014) Staphylococcus aureus bacteremia in hospitalized children under 3 months of age. thesis, Medicine.

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Abstract

S. aureus is a common pathogen with an incidence rate of 28.4 to 35.4 per 100,000 inhabitants per year. Across all age groups and demographics, S. aureus is associated with the occurrence of a wide spectrum of diseases severity. Over time, S. aureus has developed resistance to many antibiotic classes. Children have a higher S. aureus colonization rate than adults, and both S. aureus susceptible to methicillin (MSSA) and MRSA have an uncommonly high incidence rates for infants. The rate of mortality and morbidity is high in all age groups, making effective treatment of S. aureus an imperative. This study aims to help improve the epidemiological knowledge and management of S. aureus and MRSA bacteremia in children, particularly as compared with that of adult patients. Methods and Materials: Using the Children’s Hospital of Philadelphia’s (CHOP) medical record collecting programs “Chartmaxx” and “EPIC” data was extracted from the electronic medical records of 151 neonates and young infants who had been admitted to CHOP with S. aureus bacteremia spanning the time from January 2002 until December 2012. Demographics, medical history and clinical manifestation, antibiotic use and culture information was extracted. Statistic analysis was done using SPSS 20.0. Results: The 151 patients included were all under the age of 3 months; 71 were neonates and 80 were young infants. Gender was divided 44% females to 56% males and the most represented racial group was Caucasian with 49%. Patients were discharged on average 91 days after admission, with a quarter of all patients being admitted on the day of their birth. 30-day mortality was 8%. The most common comorbidity was a congenital cardiac disease, 49 of the 74 children having also received cardiac surgery within a month of prior to onset of bacteremia. Infectious Disease consults resulted in significantly more echocardiograms being made; in total 10 patients had an abnormal echocardiogram suggestive of endocarditis. 79% of the patients were admitted to the ICU at least one day during their stay. 20% of all isolated cultures were MRSA; laboratory values comparing MSSA to MRSA patients showed few significantly different values. Antibiotic use was non-patterned and very heterogeneous. Discussion and conclusion: This study shows that the need for an evidence-based guideline is high; it is difficult to distinguish between MRSA and MSSA without a susceptibility test. This makes the need for proper infection control measures in the pediatric population more important. The empirical choices of treatment initiated during the first three days after the first positive culture were diverse and un-cohesive, also suggesting a need for an evidence-based guideline. ID consults were proven to increase the amount of echocardiograms performed, reducing the risk of missing an endocarditis.

Item Type:	Thesis (Thesis)
Supervisor name:	Werf, prof. dr. T.S. (Tjip) van der
Supervisor name:	Gerber, Jeffrey S. MD and Larru, Beatriz MD and Children’s Hospital of Philadelphia, Philadelphia Pennsylvan
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:49
Last Modified:	25 Jun 2020 10:49
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/989

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