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Pediatr Infect Vaccine. 2019 Apr;26(1):11-21. Korean.
Published online Jan 25, 2019.  https://doi.org/10.14776/piv.2019.26.e2
Copyright © 2019 The Korean Society of Pediatric Infectious Diseases
Epidemiology of Staphylococcus aureus Bacteremia in Children at a Single Center from 2002 to 2016
Seonhee Lim, Seok Gyun Ha, Hann Tchah, In Sang Jeon, Eell Ryoo, Dong Woo Son, Hye Jung Cho, Yong Han Sun, Hyo Jung Kim, Jung Min Ahn and Hye-Kyung Cho
Department of Pediatrics, Gachon University College of Medicine, Gil Medical Center, Incheon, the Republic of Korea.

Correspondence to Hye-Kyung Cho. Department of Pediatrics, Gachon University College of Medicine, Gil Medical Center, 21 Namdongdae-ro, 774-beon-gil, Incheon 21565, the Republic of Korea. Email: hkcho@gilhospital.com
Received Sep 13, 2018; Revised Dec 27, 2018; Accepted Dec 31, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Purpose

We aimed to investigate the epidemiological characteristics of Staphylococcus aureus bacteremia in Korean children.

Methods

We retrospectively collected and analyzed data from the medical records of the patients with S. aureus bacteremia ≤18 years of age in Gil Medical Center from 2002 to 2016.

Results

A total of 212 SAB cases were detected. The annual incidence of SAB from 2002 to 2016 ranged from 0.77 to 1.95 per 1,000 patients hospitalized. The neonate group (<28 days of age) and the pediatric group (28–18 years of age) were 51.4% (n=109) and 48.6% (n=103), respectively. According to the origin of infection, there were 93 cases (43.9%) of community-associated (CA)-SAB and 119 cases (56.1%) of healthcare-associated (HA)-SAB. The rates of HA-SAB among the neonate group and among the pediatric group were 64.2% and 47.6%, respectively (P=0.015). There was no difference in complications between CA-SAB and HA-SAB, but mortality was higher in HA-SAB. The proportion of methicillin-resistance S. aureus (MRSA) was the highest in neonates (88.1%), decreased with age, and was 36.4%–37.5% among children aged ≥5 years. The MRSA proportion was 72.2%, showing no consistent trend over the period.

Conclusions

The annual incidence of SAB and the proportion of MRSA in SAB remained constant in the recent 15 years in children. Judicious decision of antimicrobial agents for treatment considering the patient's age and the origin of infection is necessary.

Keywords: Staphylococcus aureus; Bacteremia; Methicillin-resistant Staphylococcus aureus; Infant; Child

Figures


Fig. 1
Schematic diagram to classify Staphylococcus aureus bacteremia cases included in the study
Abbreviations: CA, community associated; CO-HA, community onset-healthcare associated; HO-HA, hospital onset-healthcare associated.
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Fig. 2
(A) The annual incidence of SAB and distribution of MSSA and MRSA among the SAB cases, (B) The annual MRSA proportion among the total SAB, CA-SAB, and HA-SAB cases.
Abbreviation: SAB, Staphylococcus aureus bacteremia; MSSA, methicillin-sensitive S. aureus; MRSA, methicillin-resistant S. aureus; CA-SAB, community-associated S. aureus bacteremia; HA-SAB, healthcare-associated S. aureus bacteremia; CA-MRSA, community-associated methicillin-resistant S. aureus; HA-MRSA, healthcare-associated methicillin-resistant S. aureus.
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Fig. 3
(A) Distribution of methicillin-resistance according to the age groups among CA-SAB. ORs in <28 days of age, 5–9 years of age, and 10–18 years of age are 8.64 (95% CI, 3.09–24.15; P=0.000), 0.09 (95% CI, 0.01–0.73; P=0.009), and 0.08 (95% CI, 0.02–0.37; P=0.000), respectively. (B) Distribution of methicillin-resistance according to the age groups among HA-SAB. ORs in <28 days group and 10–18 years group are 3.25 (95% CI, 1.19–8.89; P=0.018) and 0.21 (95% CI, 0.07–0.64; P=0.009), respectively.
Abbreviations: CA-SAB, community-associated Staphylococcus aureus bacteremia; HA-SAB, healthcare-associated S. aureus bacteremia; CA-MRSA, community-associated methicillin-resistant S. aureus; CA-MSSA, community-associated methicillin-sensitive S. aureus; OR, odds ratio; CI, confidence interval.

*P<0.05 by χ2 test.

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Tables


Table 2
Complications and mortality of Staphylococcus aureus bacteremia according to the origin of infection
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Table 3
Antimicrobial resistance and multidrug resistance of MRSA according to infection origin
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Notes

Conflict of Interest:No potential conflict of interest relevant to this article was reported.

Author Contributions:

  • Data curation: Lim S, Ha SG.

  • Formal analysis: Cho HK.

  • Investigation: Ha SG, Tchah H, Jeon IS, Ryoo E, Son DW, Cho HJ, Sun YH, Kim HJ, Ahn JM.

  • Supervision: Cho HK.

  • Writing - original draft: Lim S.

  • Writing - review & editing: Cho HK, Lim S.

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TOOLS
ORCID iDs

Seonhee Lim
https://orcid.org/0000-0001-8327-7002

Seok Gyun Ha
https://orcid.org/0000-0003-4552-6498

Hann Tchah
https://orcid.org/0000-0002-3386-4142

In Sang Jeon
https://orcid.org/0000-0001-8714-9403

Eell Ryoo
https://orcid.org/0000-0002-0785-5314

Dong Woo Son
https://orcid.org/0000-0001-7675-9855

Hye Jung Cho
https://orcid.org/0000-0001-5872-4923

Yong Han Sun
https://orcid.org/0000-0003-1527-6782

Hyo Jung Kim
https://orcid.org/0000-0003-2191-5341

Jung Min Ahn
https://orcid.org/0000-0003-1234-5308

Hye-Kyung Cho
https://orcid.org/0000-0003-0990-1350

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