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.
R. F. Hamdy,
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