In Reply We thank Schlapbach and MacLaren for their letter and comments on our article.1Staphylococcus aureus infections are the most common cause for admission to a pediatric intensive care unit for treatment of sepsis.2 We agree that vancomycin use as a risk factor for mortality in our study1 might in fact represent severity of disease rather than a problem with the antibiotic as such. We also agree that robust treatment protocols for S aureus–associated sepsis are urgently required. However, the evidence base to inform such protocols is sorely lacking. Important questions about the epidemiology and clinical treatment of staphylococcal bacteremia and sepsis remain, including optimal choice and duration of antibiotic therapy, benefit from combination therapy or antitoxin therapy, timing of intravenous to oral stepdown, and the role of further investigations such as echocardiography in children.
McMullan BJ, Bowen AC, Tong SYC. Targeting Staphylococcus aureus in Pediatric Surviving Sepsis Bundles—Reply. JAMA Pediatr. 2017;171(3):301-302. doi:10.1001/jamapediatrics.2016.4689