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.
T. Zaoutis, Astellas: Consultant , Consulting fee
Merck: Grant Investigator , Research grant
nabriva: Consultant , Consulting fee
J. S. Gerber, None