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Clinical and Molecular Epidemiology of Staphylococcus aureus Catheter-Related Bacteremia in Children

Carrillo-Marquez, Maria A. MD*†; Hulten, Kristina G. PhD*†; Mason, Edward O. PhD*†; Kaplan, Sheldon L. MD*†

The Pediatric Infectious Disease Journal: May 2010 - Volume 29 - Issue 5 - p 410-414
doi: 10.1097/INF.0b013e3181c767b6
Original Studies

Background: Staphylococcus aureus (SA) is an important cause of catheter-related bacteremia (CRB). The USA300 clone increasingly causes healthcare associated infections. We compared children with SA-CRB due to USA300 versus non-USA300 isolates and identified risk factors for complications.

Methods: Children at Texas Children's Hospital (TCH) with SA-CRB were identified from a prospective S. aureus surveillance study. S. aureus isolates were characterized by methicillin susceptibility and pulsed field gel electrophoresis.

Results: From August 2001 to October 2007, 112 children with a first episode of SA-CRB and corresponding isolates were identified. USA300 accounted for 21 isolates. Metastatic infection complicated 10.7% of cases and was associated with methicillin resistance. Other complications were recurrence (n = 16), death (n = 13), thrombosis (n = 9), and intravascular “cast” (n = 6). Four patients with non-USA300 SA-CRB had endocarditis. Prolonged bacteremia was more common in methicillin-resistant SA (12/29) than in methicillin-susceptible SA SA-CRB (14/83) (P = 0.007). Complications were more common in patients with bacteremia ≥4 days (16/26 [61.5%]) versus patients with bacteremia <4 days (25/86 [29%]) (P = 0.003). The complication rate was lower in patients who had the catheter removed <4 days (22.5%) versus patients whose catheter was removed ≥4 days after infection or not removed (44.4%) (P = 0.02). Children with USA300 versus non-USA300 isolates did not differ with respect to frequency or type of complications.

Conclusions: At Texas Children's Hospital, the USA300 clone caused 19% of initial SA-CRB episodes and was associated with methicillin resistance. Complications occurred in 36.6% of the patients and were associated with prolonged bacteremia and catheter removal ≥4 days after infection or failure to remove the catheter.

From the *Department of Pediatrics, Infectious Diseases Section, Baylor College of Medicine, Houston, TX; and †Infectious Diseases Service, Texas Children's Hospital, Houston, TX.

Accepted for publication October 22, 2009.

Supported in part by Pfizer, Inc. and the Boyd Morse Foundation.

Address for correspondence: Maria A. Carrillo-Marquez, MD, Texas Children's Hospital, Feigin Center, Suite 1150, 1102 Bates St, MC 3–2371, Houston, TX 77030. E-mail: mamarque@bcm.edu.

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© 2010 Lippincott Williams & Wilkins, Inc.