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Originally published by 2 Minute Medicine® (view original article). Reused on AccessPediatrics with permission.

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1. While mortality rates among children hospitalized with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia were low, treatment failure and infection-related complications rates were high.

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2. Musculoskeletal infections, endovascular infections, and critical illness were associated with increased odds of treatment failure, whereas low initial vancomycin serum concentrations were not found to be a risk factor for treatment failure.

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Evidence Rating Level: 2 (Good)

Study Rundown:

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MRSA bacteremia is associated with high morbidity and mortality rates in adults, but the epidemiology, risk factors for treatment failure, and clinical outcomes in children have not been well studied. In this retrospective cohort analysis, researchers attempted to better understand the clinical epidemiology of MRSA bacteremia in children, as well as identify risk factors for treatment failure in this population. Results showed that despite high rates of treatment failure and complications, mortality rates were low in children. Musculoskeletal infections, endovascular infections and critical illness were associated with increased odds of treatment failure. Initial vancomycin, the standard treatment for MRSA, serum concentrations were not found to be associated with treatment failure. Results also showed that odds of experiencing complications increased with each additional day of bacteremia. As a retrospective cohort, this study is limited by potential misclassifications and missing data in the medical records analyzed. Findings from this study emphasize the importance of achieving rapid sterilization to prevent complications in children with MRSA bacteremia. Results also indicate the need for further studies to investigate optimal vancomycin dose and duration to maximize patient outcomes.

In-depth [retrospective cohort]:

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Researchers analyzed medical records from 232 hospitalizations related to MRSA bacteremia in kids <19 years of age (42.2% female, median age 5.3 years, 52.2% with comorbid conditions) treated at 3 large tertiary care children’s hospitals between 2007 and 2014. Results showed the primary sources of MRSA infection were osteomyelitis (31%), catheter-related (22.4%), and skin and soft tissue infections (15%). A total of 205 of the 232 episodes were treated with vancomycin within the first 48 hours. Treatment failure was defined as MRSA related death within 30 days, MRSA bacteremia lasting >3 days, or MRSA bacteremia recurring within 30 days of initial treatment. Overall, 72 children (31%) experienced treatment failure 64 of whom had persistent bacteremia >3 days. Fifty-four (23%) study subjects experienced bacteremia related complications or sequelae, and 5 children (2.2%) died due to MRSA bacteremia. Analysis for risk factors related to treatment failure were limited to the 174 study participants who reached a vancomycin steady state. Results showed endovascular infection (OR 4.45, 95%CI: 1.09–18.2), musculoskeletal infection (OR, 2.4, 95%CI: 1.08–5.16), and critical illness (OR 2.77, 95%CI: 1.02–7.5) to be associated with increased odds of treatment failure, whereas catheter-related infection (OR 0.36, 95%CI 0.13–0.94) was associated with lower odds of treatment failure. An initial vancomycin trough ≤10ug/mL was not associated with treatment failure (OR 1.34, 95%CI: 0.49–3.66). Finally, this study showed that every 1-day increase in the duration of bacteremia was associated with a 50% increase in the odds of developing a complication (95%CI: 26%–79%).

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