Staphylococcus aureus bacteremia in children: Epidemiology and clinical features
- Vance G Fowler, Jr, MD
Vance G Fowler, Jr, MD
- Professor of Medicine
- Duke University Medical Center
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
Staphylococcus aureus is a leading cause of both community- and healthcare-associated bacteremia. S. aureus bacteremia (SAB) is associated with increased morbidity and mortality, even with appropriate therapy.
The epidemiology and clinical features of SAB in children will be reviewed here. The management and outcome of SAB in children are discussed separately. (See "Staphylococcus aureus bacteremia in children: Management and outcome".)
Bacteremia caused by S. aureus can be divided into the following categories:
●Healthcare-associated, which includes both:
- Suryati BA, Watson M. Staphylococcus aureus bacteraemia in children: a 5-year retrospective review. J Paediatr Child Health 2002; 38:290.
- Burke RE, Halpern MS, Baron EJ, Gutierrez K. Pediatric and neonatal Staphylococcus aureus bacteremia: epidemiology, risk factors, and outcome. Infect Control Hosp Epidemiol 2009; 30:636.
- Asgeirsson H, Gudlaugsson O, Kristinsson KG, et al. Low mortality of Staphylococcus aureus bacteremia in Icelandic children: nationwide study on incidence and outcome. Pediatr Infect Dis J 2015; 34:140.
- Iwamoto M, Mu Y, Lynfield R, et al. Trends in invasive methicillin-resistant Staphylococcus aureus infections. Pediatrics 2013; 132:e817.
- Steinberg JP, Clark CC, Hackman BO. Nosocomial and community-acquired Staphylococcus aureus bacteremias from 1980 to 1993: impact of intravascular devices and methicillin resistance. Clin Infect Dis 1996; 23:255.
- Morin CA, Hadler JL. Population-based incidence and characteristics of community-onset Staphylococcus aureus infections with bacteremia in 4 metropolitan Connecticut areas, 1998. J Infect Dis 2001; 184:1029.
- Ruebner R, Keren R, Coffin S, et al. Complications of central venous catheters used for the treatment of acute hematogenous osteomyelitis. Pediatrics 2006; 117:1210.
- Tong SY, Davis JS, Eichenberger E, et al. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28:603.
- Ligon J, Kaplan SL, Hulten KG, et al. Staphylococcus aureus bacteremia without a localizing source in pediatric patients. Pediatr Infect Dis J 2014; 33:e132.
- Mejer N, Westh H, Schønheyder HC, et al. Stable incidence and continued improvement in short term mortality of Staphylococcus aureus bacteraemia between 1995 and 2008. BMC Infect Dis 2012; 12:260.
- Vanderkooi OG, Gregson DB, Kellner JD, Laupland KB. Staphylococcus aureus bloodstream infections in children: A population-based assessment. Paediatr Child Health 2011; 16:276.
- Watson RS, Carcillo JA, Linde-Zwirble WT, et al. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med 2003; 167:695.
- Gerber JS, Coffin SE, Smathers SA, Zaoutis TE. Trends in the incidence of methicillin-resistant Staphylococcus aureus infection in children's hospitals in the United States. Clin Infect Dis 2009; 49:65.
- Cobos-Carrascosa E, Soler-Palacín P, Nieves Larrosa M, et al. Staphylococcus aureus Bacteremia in Children: Changes During Eighteen Years. Pediatr Infect Dis J 2015; 34:1329.
- Klieger SB, Vendetti ND, Fisher BT, Gerber JS. Staphylococcus aureus bacteremia in hospitalized children: incidence and outcomes. Infect Control Hosp Epidemiol 2015; 36:603.
- Miles F, Voss L, Segedin E, Anderson BJ. Review of Staphylococcus aureus infections requiring admission to a paediatric intensive care unit. Arch Dis Child 2005; 90:1274.
- Dawood FS, Chaves SS, Pérez A, et al. Complications and associated bacterial coinfections among children hospitalized with seasonal or pandemic influenza, United States, 2003-2010. J Infect Dis 2014; 209:686.
- Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Pediatrics 1999; 103:e39.
- Gaynes RP, Edwards JR, Jarvis WR, et al. Nosocomial infections among neonates in high-risk nurseries in the United States. National Nosocomial Infections Surveillance System. Pediatrics 1996; 98:357.
- Wisplinghoff H, Seifert H, Tallent SM, et al. Nosocomial bloodstream infections in pediatric patients in United States hospitals: epidemiology, clinical features and susceptibilities. Pediatr Infect Dis J 2003; 22:686.
- Frederiksen MS, Espersen F, Frimodt-Møller N, et al. Changing epidemiology of pediatric Staphylococcus aureus bacteremia in Denmark from 1971 through 2000. Pediatr Infect Dis J 2007; 26:398.
- Denniston S, Riordan FA. Staphylococcus aureus bacteraemia in children and neonates: a 10 year retrospective review. J Infect 2006; 53:387.
- Hakim H, Mylotte JM, Faden H. Morbidity and mortality of Staphylococcal bacteremia in children. Am J Infect Control 2007; 35:102.
- Hultén KG, Kaplan SL, Lamberth LB, et al. Hospital-acquired Staphylococcus aureus infections at Texas Children's Hospital, 2001-2007. Infect Control Hosp Epidemiol 2010; 31:183.
- Fortunov RM, Hulten KG, Hammerman WA, et al. Community-acquired Staphylococcus aureus infections in term and near-term previously healthy neonates. Pediatrics 2006; 118:874.
- Gray JW. A 7-year study of bloodstream infections in an English children's hospital. Eur J Pediatr 2004; 163:530.
- Valente AM, Jain R, Scheurer M, et al. Frequency of infective endocarditis among infants and children with Staphylococcus aureus bacteremia. Pediatrics 2005; 115:e15.
- Friedman ND, Kaye KS, Stout JE, et al. Health care--associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002; 137:791.
- Hultén KG, Kaplan SL, Gonzalez BE, et al. Three-year surveillance of community onset health care-associated staphylococcus aureus infections in children. Pediatr Infect Dis J 2006; 25:349.
- Khairulddin N, Bishop L, Lamagni TL, et al. Emergence of methicillin resistant Staphylococcus aureus (MRSA) bacteraemia among children in England and Wales, 1990-2001. Arch Dis Child 2004; 89:378.
- Park DA, Lee SM, Peck KR, et al. Impact of Methicillin-Resistance on Mortality in Children and Neonates with Staphylococcus aureus Bacteremia: A Meta-analysis. Infect Chemother 2013; 45:202.
- Buckingham SC, McDougal LK, Cathey LD, et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus at a Memphis, Tennessee Children's Hospital. Pediatr Infect Dis J 2004; 23:619.
- Mishaan AM, Mason EO Jr, Martinez-Aguilar G, et al. Emergence of a predominant clone of community-acquired Staphylococcus aureus among children in Houston, Texas. Pediatr Infect Dis J 2005; 24:201.
- Sattler CA, Mason EO Jr, Kaplan SL. Prospective comparison of risk factors and demographic and clinical characteristics of community-acquired, methicillin-resistant versus methicillin-susceptible Staphylococcus aureus infection in children. Pediatr Infect Dis J 2002; 21:910.
- Kaplan SL, Hulten KG, Gonzalez BE, et al. Three-year surveillance of community-acquired Staphylococcus aureus infections in children. Clin Infect Dis 2005; 40:1785.
- Naimi TS, LeDell KH, Como-Sabetti K, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003; 290:2976.
- Moran GJ, Krishnadasan A, Gorwitz RJ, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006; 355:666.
- Gonzalez BE, Teruya J, Mahoney DH Jr, et al. Venous thrombosis associated with staphylococcal osteomyelitis in children. Pediatrics 2006; 117:1673.
- Herold BC, Immergluck LC, Maranan MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998; 279:593.
- Centers for Disease Control and Prevention (CDC). Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus — Minnesota and North Dakota, 1997-1999. MMWR Morb Mortal Wkly Rep 1999; 48:707.
- Collignon P, Gosbell I, Vickery A, et al. Community-acquired meticillin-resistant Staphylococcus aureus in Australia. Australian Group on Antimicrobial Resistance. Lancet 1998; 352:145.
- Filippin L, Roisin S, Nonhoff C, et al. Evaluation of the automated Vitek 2 system for detection of various mechanisms of macrolide and lincosamide resistance in Staphylococcus aureus. J Clin Microbiol 2014; 52:4087.
- McGehee RF R, Barre FF, Finland M. Resistance of Staphylococcus aureus to lincomycin, clinimycin, and erythromycin. Antimicrob Agents Chemother (Bethesda) 1968; 8:392.
- Panagea S, Perry JD, Gould FK. Should clindamycin be used as treatment of patients with infections caused by erythromycin-resistant staphylococci? J Antimicrob Chemother 1999; 44:581.
- Drinkovic D, Fuller ER, Shore KP, et al. Clindamycin treatment of Staphylococcus aureus expressing inducible clindamycin resistance. J Antimicrob Chemother 2001; 48:315.
- Siberry GK, Tekle T, Carroll K, Dick J. Failure of clindamycin treatment of methicillin-resistant Staphylococcus aureus expressing inducible clindamycin resistance in vitro. Clin Infect Dis 2003; 37:1257.
- Frank AL, Marcinak JF, Mangat PD, et al. Clindamycin treatment of methicillin-resistant Staphylococcus aureus infections in children. Pediatr Infect Dis J 2002; 21:530.
- Centers for Disease Control and Prevention (CDC). Staphylococcus aureus with reduced susceptibility to vancomycin--Illinois, 1999. MMWR Morb Mortal Wkly Rep 2000; 48:1165.
- Carrillo-Marquez MA, Hulten KG, Mason EO, Kaplan SL. Clinical and molecular epidemiology of Staphylococcus aureus catheter-related bacteremia in children. Pediatr Infect Dis J 2010; 29:410.
- Burton DC, Edwards JR, Horan TC, et al. Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997-2007. JAMA 2009; 301:727.
- Levy I, Bendet M, Samra Z, et al. Infectious complications of peripherally inserted central venous catheters in children. Pediatr Infect Dis J 2010; 29:426.
- Raad II, Sabbagh MF. Optimal duration of therapy for catheter-related Staphylococcus aureus bacteremia: a study of 55 cases and review. Clin Infect Dis 1992; 14:75.
- Malanoski GJ, Samore MH, Pefanis A, Karchmer AW. Staphylococcus aureus catheter-associated bacteremia. Minimal effective therapy and unusual infectious complications associated with arterial sheath catheters. Arch Intern Med 1995; 155:1161.
- ELEK SD, CONEN PE. The virulence of Staphylococcus pyogenes for man; a study of the problems of wound infection. Br J Exp Pathol 1957; 38:573.
- Kirmani N, Tuazon CU, Murray HW, et al. Staphylococcus aureus carriage rate of patients receiving long-term hemodialysis. Arch Intern Med 1978; 138:1657.
- Tuazon CU, Perez A, Kishaba T, Sheagren JN. Staphylococcus aureus among insulin-injecting diabetic patients. An increased carrier rate. JAMA 1975; 231:1272.
- Yu VL, Goetz A, Wagener M, et al. Staphylococcus aureus nasal carriage and infection in patients on hemodialysis. Efficacy of antibiotic prophylaxis. N Engl J Med 1986; 315:91.
- Jacobsson G, Dashti S, Wahlberg T, Andersson R. The epidemiology of and risk factors for invasive Staphylococcus aureus infections in western Sweden. Scand J Infect Dis 2007; 39:6.
- Waldvogel FA. Staphylococcus aureus (including toxic shock). In: Principles and Practice of Infectious Diseases, 4th ed, Mandell GL, Bennett JE, Dolin R (Eds), Churchill Livingstone, New York 1995. p.1754.
- Wertheim HF, Vos MC, Ott A, et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet 2004; 364:703.
- Holtfreter S, Roschack K, Eichler P, et al. Staphylococcus aureus carriers neutralize superantigens by antibodies specific for their colonizing strain: a potential explanation for their improved prognosis in severe sepsis. J Infect Dis 2006; 193:1275.
- Hospital-onset healthcare-acquired
- Community-onset healthcare-associated
- ANTIMICROBIAL RESISTANCE
- Methicillin resistance
- - Community-associated MRSA
- Clindamycin resistance
- Vancomycin resistance
- RISK FACTORS
- Intravascular catheters
- Implanted foreign body
- Underlying medical conditions
- Nasal colonization
- Injection drug use
- CLINICAL FEATURES
- Toxic shock syndrome
- Septic arthritis
- Skin and soft tissue infections
- Intravascular catheter infection
- Infective endocarditis