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Original Investigation
October 2016

Epidemiology and Mortality of Staphylococcus aureus Bacteremia in Australian and New Zealand Children

Author Affiliations
  • 1Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Randwick, New South Wales, Australia
  • 2School of Women’s and Children’s Health, University of New South Wales, New South Wales, Australia
  • 3Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
  • 4Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
  • 5Menzies School of Health Research, Darwin, Northern Territory, Australia
  • 6School of Pediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia
  • 7Department of Microbiology, Princess Margaret Hospital, PathWest Laboratory Medicine, Western Australia, Australia
  • 8Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital Camperdown, Sydney, New South Wales, Australia
  • 9Monash Infectious Diseases, Monash University, Monash Health, Victoria, Australia
  • 10Department of Infection and Immunity, Monash Children’s Hospital, Department of Pediatrics, Monash University, Victoria, Australia
  • 11Department of Pediatric Infectious Disease, Starship Children’s Hospital, Auckland, New Zealand
  • 12Microbiology Department, LabPlus, Auckland Hospital, Auckland, New Zealand
  • 13Department of Microbiology and Infectious Diseases, South Australia Pathology, Women's and Children’s Hospital, North Adelaide, South Australia, Australia
  • 14Royal Darwin Hospital, Darwin, Northern Territory, Australia
  • 15Department of Anatomy and Pathology, University of Adelaide, Adelaide, South Australia, Australia
  • 16Department of Pediatrics, University of Adelaide, Adelaide, South Australia, Australia
  • 17Department of Molecular and Cellular Biology, University of Adelaide, Adelaide, South Australia, Australia
  • 18Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
JAMA Pediatr. 2016;170(10):979-986. doi:10.1001/jamapediatrics.2016.1477
Key Points

Question  What is the epidemiology of Staphylococcus aureus bacteremia (SAB) in children?

Findings  In this cohort study, 30-day mortality in 1153 Australasian children was 4.7% (50 of 1073 children with complete data on mortality), and new risk groups identified for mortality were infants younger than 1 year; Māori/Pacific children; those with pneumonia, endocarditis, or sepsis syndrome or no focus; and those who were treated with vancomycin for methicillin-susceptible SAB. Methicillin-resistant SAB and hospital-onset infection were not associated with mortality.

Meaning  Staphylococcus aureus bacteremia has a wide spectrum of manifestations in children, which differs from that in adults.


Importance  Staphylococcus aureus bacteremia (SAB) in children causes significant morbidity and mortality, but the epidemiology in children is not well characterized.

Objective  To describe the epidemiology of SAB in children and adolescents younger than 18 years from Australia and New Zealand.

Design, Setting, and Participants  A prospective cohort study, using data from the Australian New Zealand Cooperative on Outcomes in Staphylococcal Sepsis cohort for 1153 children with SAB from birth to less than 18 years in pediatric and general hospitals across Australia and New Zealand, collected between January 1, 2007, and December 31, 2012. Multivariate analysis was performed to identify risk factors for mortality. Incidence calculations were calculated separately for Australasian children younger than 15 years using postcode population denominator data from Australian and New Zealand census data.

Main Outcomes and Measures  Demographic data, hospital length of stay, principal diagnosis, place of SAB onset (community or hospital), antibiotic susceptibility and principal antibiotic treatment, and 7- and 30-day mortality.

Results  Of the 1153 children with SAB, complete outcome data were available for 1073 children (93.1%); of these, males accounted for 684 episodes (63.7%) of SAB. The median age was 57 months (interquartile range, 2 months to 12 years). The annual incidence of SAB for Australian children was 8.3 per 100 000 population and was higher in indigenous children (incident rate ratio, 3.0 [95% CI, 2.4-3.7]), and the incidence for New Zealand children was 14.4 per 100 000 population and was higher in Māori children (incident rate ratio, 5.4 [95% CI, 4.1-7.0]). Community-onset SAB occurred in 761 cases (70.9%), and 142 cases (13.2%) of the infections were methicillin-resistant S aureus (MRSA). Bone or joint infection was most common with 348 cases (32.4%), and endocarditis was uncommon with 30 cases (2.8%). Seven- and 30-day mortality rates were 2.6% (n = 28) and 4.7% (n = 50), respectively. Risk factors for mortality were age younger than 1 year; Māori or Pacific ethnicity; endocarditis, pneumonia, or sepsis; and receiving no treatment or treatment with vancomycin. Mortality was 14.0% (6 of 43) in children with methicillin-susceptible S aureus (MSSA) treated with vancomycin compared with 2.6% (22 of 851) in children treated with alternative agents (OR, 6.1 [95% CI, 1.9-16.7]). MRSA infection was associated with increased length of stay but not mortality.

Conclusions and Relevance  In this large cohort study of the epidemiology of SAB in children, death was uncommon, but the incidence was higher for infants and varied by treatment, ethnicity, and clinical presentation. This study provides important information on the epidemiology of SAB in children and risk factors for mortality.