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Invasive Staphylococcus aureus Infections in Children in Tropical Northern Australia

Engelman, Daniel, Hofer, Alexandra, Davis, Joshua S., Carapetis, Jonathan R., Baird, Robert W., Giffard, Philip M., Holt, Deborah C. and Tong, Steven Y. C. (2014). Invasive Staphylococcus aureus Infections in Children in Tropical Northern Australia. Journal of the Pediatric Infectious Diseases Society,3(4):304-311.

Document type: Journal Article
Citation counts: Altmetric Score Altmetric Score is 3
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IRMA ID 11436xPUB58
Title Invasive Staphylococcus aureus Infections in Children in Tropical Northern Australia
Author Engelman, Daniel
Hofer, Alexandra
Davis, Joshua S.
Carapetis, Jonathan R.
Baird, Robert W.
Giffard, Philip M.
Holt, Deborah C.
Tong, Steven Y. C.
Journal Name Journal of the Pediatric Infectious Diseases Society
Publication Date 2014
Volume Number 3
Issue Number 4
ISSN 2048-7193   (check CDU catalogue open catalogue search in new window)
Start Page 304
End Page 311
Total Pages 8
Place of Publication United Kingdom
Publisher Oxford University Press
HERDC Category C1 - Journal Article (DIISR)
Despite a high burden of staphylococcal skin disease in children and high incidence of Staphylococcus aureus bacteremia in adult Indigenous populations in northern Australia, there are few studies describing incidence or clinical information of invasive S aureus (ISA) infections in children.
We conducted a retrospective review for all cases of S aureus bacteremia and sterile site infections, for children under 15 years, in northern Australia over a 4-year period (2007–2010). Cases were categorized as neonatal (<28 days) and pediatric (≥28 days).
Results Forty-four cases (9 neonatal, 35 pediatric) were identified. The annual incidence of ISA was 27.9 cases per 100 000 population. Among pediatric cases, the annual incidence was significantly higher in the Indigenous (46.6) compared with the non-Indigenous (4.4) population (IRR: 10.6 [95% confidence interval, 3.8–41.4]). Pediatric infections were predominantly community-associated (86%). Clinical infection sites included osteoarticular (66%), pleuropulmonary (29%), and endocarditis (9%), and multifocal disease was common (20%). Eighty-three percent of pediatric cases presented with sepsis; 34% resulted in intensive care admission. Neonatal cases were all born prematurely; 89% were late-onset infections. Overall, 27% of infections were due to methicillin-resistant S aureus (MRSA). Compared with methicillin-sensitive S aureus (MSSA), there was no difference in severity or presentation in pediatric MRSA cases, but a higher proportion of MRSA cases were readmitted.
Conclusions The annual incidence of ISA infection in this study is among the highest described, largely due to a disproportionate burden in Indigenous children. Infections are frequently severe and infection with MRSA is common. Children presenting with suspected ISA in this region should be treated empirically for MRSA.

Keywords Bacteremia
Staphylococcus aureus
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