835. Risk Factors for Treatment Failure and Clinical Outcomes of Methicillin-Resistant Staphylococcus aureus Bacteremia in Children
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 9, 2015
Room: Poster Hall
Posters
  • 835_Hamdy_Risk factors MRSA bacteremia children.pdf (267.4 kB)
  • Background: Methicillin-resistant Staphylococcus aureus(MRSA) bacteremia is associated with substantial morbidity and mortality in adults. The epidemiology and outcomes associated with MRSA bacteremia in children have not been well elucidated. Risk factors for treatment failure identified in adults, including inadequate initial vancomycin concentration, have not been studied in children. Current IDSA guidelines extrapolate from adult studies to determine pediatric treatment recommendations. 

    Methods: We conducted a multi-center retrospective cohort study of children ≤18 years hospitalized with MRSA bacteremia at one of three tertiary care children’s hospitals between 2011-2014. We excluded polymicrobial infections and recurrent MRSA bacteremia within 30 days of completion of therapy. We defined treatment failure as a composite outcome including persistent bacteremia > 3 days, recurrence of bacteremia within 30 days, or attributable 30-day mortality. We evaluated the association between each exposure and treatment failure using multivariate logistic regression. 

    Results: We identified 116 episodes of MRSA bacteremia. Mean age was 6.7 years, 84% were community onset infections, 53.4% occurred in children with underlying chronic medical conditions, and 40.5% occurred in children with indwelling devices at time of onset of bacteremia. The primary source of infection was bone/joint in 40.5%, central line associated bloodstream infection (CLABSI) in 25%, skin/soft tissue infections in 18%, and pneumonia in 8%. Overall, 33 (28%) experienced treatment failure, including 29 (25%) with persistence of bacteremia, 6 patients (5%) with recurrence, and 1 death. In a multivariate analysis of 112 patients treated with vancomycin including age, severity of illness, and first vancomycin trough level, none of these variables was associated with treatment failure. 

    Conclusion: While attributable mortality in this cohort of children with MRSA bacteremia was extremely low, more than one quarter of children experienced treatment failure. Lower vancomycin troughs were not associated with treatment failure.

    Rana F. Hamdy, MD, MPH, Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, Alice J Hsu, PharmD, The Johns Hopkins Hospital, Baltimore, MD, Chris R. Stockmann, MSc, Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, Jared a. Olson, PharmD, Primary Children's Medical Center, Salt Lake City, UT, Matthew Bryan, PhD, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, Adam L. Hersh, MD, PhD, University of Utah School of Medicine, Salt Lake City, UT, Pranita D. Tamma, MD, MHS, Department of Pediatrics, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD and Jeffrey S. Gerber, MD, PhD, Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA

    Disclosures:

    R. F. Hamdy, None

    A. J. Hsu, None

    C. R. Stockmann, None

    J. A. Olson, None

    M. Bryan, None

    A. L. Hersh, Pfizer: Grant Investigator , Grant recipient and Research grant

    P. D. Tamma, None

    J. S. Gerber, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.