2171. Treatment of Staphylococcus aureus bacteremia in children: is intravenous therapy always needed?
Session: Poster Abstract Session: HAI: MRSA, MSSA, and Other Gram Positives
Saturday, October 7, 2017
Room: Poster Hall CD
Background:Traditionally, prolonged courses of intravenous antibiotics have been recommended to treat Staphylococcus aureus bacteremia . However, this approach can be associated with catheter-related complications and can be costly. The purpose of our study was to describe the treatment regimens and outcomes of children with S. aureus bacteremia.

Methods:We conducted a single center retrospective cohort study over a 5-year period including all children ≤18 years hospitalized with S. aureus bacteremia . We excluded children with polymicrobial bloodstream infections and with incomplete records. We compared baseline characteristics and clinical outcomes between those treated with intravenous (IV)-only antibiotics, >7 days IV course followed by oral antibiotics (LongIV+PO) and <7 days IV course followed by oral switch (ShortIV+PO), using Pearson’s chi-squared test to compare dichotomous variables.

Results:We identified 314 episodes of S. aureus bacteremia. Most (59.9%) received IV-only regimen, 61/314 (19.4%) were treated with LongIV+PO and 65/314 (20.7%) treated with ShortIV+PO. The mean age was 4.2 years for those treated with the IV-only regimen compared to 6.7 years and 8.3 years for children treated with LongIV+PO and ShortIV+PO regimens respectively. Catheter-related infections were more frequently treated with IV-only (85% IV-only; 9% LongIV+PO; 6% ShortIV+PO), as was pneumonia (61% IV-only; 28% LongIV+PO; 11% ShortIV+PO), whereas musculoskeletal infections (25.6% IV-only; 29.5% LongIV+PO; 44.9% ShortIV+PO), and skin/soft tissue infections (35% IV-only; 27.5% LongIV+PO; 37.5% ShortIV+PO) were more commonly treated with a short IV course. Recurrence of infection within 30 days occurred in 5/176 (2.8%) of those in the IV-only regimen, in 1/60 (1.7%) who received the LongIV+PO regimen, and in 2/63 (3.2%) of those in the ShortIV+PO regimen (p=0.85).

Conclusion: In this cohort study of children with S. aureus bacteremia, most were treated with IV-only course, while 40% were transitioned to an oral regimen after either a short or long IV course. Infections arising from a skin/soft tissue or musculoskeletal source were more likely to be transitioned to a PO regimen. Recurrence rates in the antibiotic route regimen groups were similar.

Daniele Dona, MD, , Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, Philadelphia, PA, United States Minor Outlying Islands, Rana F. Hamdy, MD, MPH, MSCE, 2701 Calvert St., 2701 Calvert St., Washington, DC, Theoklis Zaoutis, MD, MSCE, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA and Jeffrey S. Gerber, MD, PhD, Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA


D. Dona, None

R. F. Hamdy, None

T. Zaoutis, Astellas: Consultant , Consulting fee
Merck: Grant Investigator , Research grant
nabriva: Consultant , Consulting fee

J. S. Gerber, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.