title: Clinical variables and Staphylococcus aureus virulence factors associated with venous thromboembolism in children.
abstract: OBJECTIVE
  Children with Staphylococcus aureus (SA) bacteremia risk developing venous thromboembolism (VTE). We sought to identify clinical variables and bacterial virulence factors associated with VTE in SA bacteremia.
  
  
  METHODS
  This is a single-institution retrospective study of 229 children with SA bacteremia hospitalized from 2005 to 2008. Clinical data were abstracted from patient charts. Two-hundred three SA isolates were analyzed by polymerase chain reaction. The Pediatric Health Information System (PHIS) database was queried to identify subjects with a central venous line (CVL) or complex chronic conditions (CCC). Logistic regression analysis was employed to determine which factors most greatly influenced VTE.
  
  
  RESULTS
  VTE was present in 9.2% (n=21/229). Superficial thrombi were excluded. Mortality was greater in patients with VTE [24% vs. 6% (p=0.016)]. Among SA isolates available for virulence testing, the majority (70%; n=139) were methicillin-sensitive SA (MSSA). Methicillin-resistant SA (MRSA) infection was associated with VTE (p=0.01). The most common sites of thrombosis were extremity deep vein (58%; n=14/24), head/neck (29%; n=7), and visceral (13%; n=3). One subject had a pulmonary embolism. The presence of a CVL or a CCC was not associated with VTE. Independent predictors of VTE were C-reactive protein (CRP)≥20mg/dl [OR 4.2, 95% CI 1.16-15.25] and hemoglobin nadir ≤9g/dl [OR 5.2, 95% CI 1.3-20.64].
  
  
  CONCLUSIONS
  In addition to MRSA infection, CRP≥20mg/dl and hemoglobin nadir ≤9g/dl were associated with VTE in SA bacteremia. These factors may serve as markers for increased risk of VTE with invasive SA disease.
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States; Division of Pediatric Hematology/Oncology/BMT, Children's Mercy Hospital, Kansas City, MO, United States. Electronic address: slcarpenter@cmh.edu.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Carpenter
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States; Division of Pediatric Infectious Diseases, Children's Mercy Hospital, Kansas City, MO, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Goldman
authors.affiliation: Department of Research Development and Clinical Investigation, Children's Mercy Hospital, Kansas City, MO, United States.
authors.forename: Ashley K
authors.initials: AK
authors.lastname: Sherman
authors.affiliation: Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, United States.
authors.forename: J
authors.initials: J
authors.lastname: Jeremiah Bell
authors.affiliation: Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, United States.
authors.forename: Suresh
authors.initials: S
authors.lastname: Selveraju
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States; Division of Pediatric Infectious Diseases, Children's Mercy Hospital, Kansas City, MO, United States.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
authors.affiliation: Department of Orthopedic Surgery, Children's Mercy Hospital, Kansas City, MO, United States.
authors.forename: Dale E
authors.initials: DE
authors.lastname: Jarka
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States; Division of Pediatric Hematology/Oncology/BMT, Children's Mercy Hospital, Kansas City, MO, United States.
authors.forename: Katherine
authors.initials: K
authors.lastname: Chastain
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States; Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, United States.
authors.forename: Rangaraj
authors.initials: R
authors.lastname: Selvarangan
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000097:blood / Q000150:complications* / Q000382:microbiology; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000097:blood / Q000150:complications* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D054556:Venous Thromboembolism / Q000097:blood / Q000150:complications* / Q000382:microbiology*; D037521:Virulence Factors / Q000032:analysis
chemical_list: D006454:Hemoglobins; D037521:Virulence Factors; D002097:C-Reactive Protein
keywords: Anemia; Bacteremia; CRP; Thrombosis; VTE; Virulence factors