title: Paediatric Staphylococcus aureus bacteraemia: A single-centre retrospective cohort.
abstract: OBJECTIVE
  We aimed to describe the clinical epidemiology of Staphylococcus aureus bacteraemia (SAB) at a large, tertiary/quaternary children's hospital in Australia.
  
  
  METHODS
  We performed a retrospective chart review of SAB cases at the Children's Hospital at Westmead (CHW) over 5 years; 2006-2011. We compared frequency, clinical profile and outcomes of SAB with published data from CHW; 1994-1998. We compared health-care associated with community-associated (HCA-SAB and CA-SAB; defined epidemiologically) and methicillin-resistant with methicillin susceptible S. aureus (MRSA and MSSA).
  
  
  RESULTS
  We identified 174 episodes of paediatric SAB with an average annual admission rate of 1.3/1000 which has not increased compared with a decade earlier. Half of the cases (49%) were CA-SAB; 18% were MRSA. The proportion of CA-MRSA bacteraemia (22%) has increased. The proportion of SAB associated with central venous access devices (CVADs; 40%) has increased. CA-SAB cases were more likely to present with a tissue focus of disease (e.g. osteo-articular, pneumonia) and often required surgery. HCA-SAB less frequently required surgery, a minority is MRSA, and vascular device intervention (removal, sterilisation) is common. Six cases (4%) of infective endocarditis (IE) were identified; three with a history of congenital heart disease, two with CVADs in situ. There were no deaths in this cohort.
  
  
  CONCLUSIONS
  Over an 18-year period, the proportion of SAB due to CA-MRSA and SAB associated with CVADs has increased. Categorisation of SAB as HCA and CA reveals two broad phenotypes of paediatric SAB. SAB in children is infrequently associated with IE. The health-care burden of paediatric SAB is considerable', but mortality is low.
authors: Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors: Jessica C
authors: JC
authors: Roediger
authors: Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors: Alexander C
authors: AC
authors: Outhred
authors: Clinical Epidemiology Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
authors: Bruce
authors: B
authors: Shadbolt
authors: Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.|Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors: Philip N
authors: PN
authors: Britton
mesh_terms: D020958:Australian Capital Territory / Q000453:epidemiology; D016470:Bacteremia / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000503:physiopathology; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D062606:Tertiary Care Centers
keywords: Staphylococcus aureus
  ; bacteraemia; endocarditis; general paediatrics; infectious diseases