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Comment & Response
March 2017

Targeting Staphylococcus aureus in Pediatric Surviving Sepsis Bundles—Reply

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, Australia
  • 7Victorian Infectious Disease Service, The Royal Melbourne Hospital
  • 8The University of Melbourne, the Peter Doherty Institute for Infection and Immunity, Victoria, Australia
JAMA Pediatr. 2017;171(3):301-302. doi:10.1001/jamapediatrics.2016.4689

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.