Community-acquired Staphylococcus aureus bacteremia in healthy children-13 years of experience in a pediatric tertiary center.

Abstract

Staphylococcus aureus (SA) is an important pathogen in the pediatric population. Community-acquired SA bacteremia (SAB) may also occur in healthy individuals, yet literature on this matter is scarce. Our study aims to describe patient characteristics, clinical course, and outcomes of healthy children with SAB. This retrospective cohort study included all healthy patients aged 3 months-18 years, with a positive SA blood culture taken during the first 72 hours of hospitalization between 2009 and 2021. Demographic, laboratory, and clinical data were collected. Analysis was performed to assess factors associated with complicated disease. Fifty-seven patients aged 8.5 ± 4.5 years were included. Forty-one (71.9%) were males and 18 (31.6%) reported trauma before onset. Thirty-four (59.6%) were diagnosed with osteomyelitis, 14 (24.6%) with abscesses, 7 (12.3%) with isolated SAB, and 7 (12.3%) suffered from complex SAB. Factors associated with abscess formation were age ≥ 13 years and groin pain; OR 3.857 (p-value 0.01) and 20.0 (p-value 0.01), respectively. A CRP ≥ 13 mg/dL upon admission was found to be a predictor of complex disease (AUC of 0.765; 95% CI 0.559-0.971 (p-value 0.024)). Higher odds for complex SAB were seen in persistent bacteremia, prolonged time to eradication, and time to targeted therapy; OR 5.833 (p-value 0.048), OR 1.810 (p-value 0.017), and OR 3.214 (p-value 0.015), respectively. There were no cases of mortality.

Conclusion: This study describes various aspects of SAB in healthy children and could help to better recognize the signs and symptoms of the disease. Moreover, we report several indicators that may assist clinicians in identifying at-risk patients for a complicated disease.

What is known: •SAB is an important pediatric disease that can cause severe complications and mortality. •SAB is well described as a nosocomial infection and in high-risk populations such as premature babies, children with intravascular devices, immunodeficient individuals, and other major chronic illnesses. However, data regarding community-acquired SAB in healthy children is lacking.

What is new: •This is the first study to exclusively include previously healthy children with community-acquired SAB. •Higher CRP upon admission, persistent bacteremia, and longer time to targeted therapy are all in correlation with complications such as multifocal disease, sepsis, ICU admission, and endocarditis.