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.
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.
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.
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: email@example.com.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.pidj.com).