The clinical spectrum of Staphylococcus aureus infections in children admitted to Chris Hani Baragwanath Academic Hospital, South Africa: A retrospective, descriptive study

Abstract

Background. Staphylococcus aureus infection is associated with considerable morbidity and mortality. There are relatively few studies describing invasive S. aureus infections in children, particularly in low- and middle-income countries.

Objectives. To describe the clinical spectrum and outcomes associated with S. aureus infection in children <14 years of age hospitalised at Chris Hani Baragwanath Academic Hospital (CHBAH), South Africa, and to identify risk factors of invasive disease.

Methods. A retrospective, descriptive study was conducted at CHBAH to define the spectrum of clinical presentation, risk factors, duration of treatment and outcomes of paediatric S. aureus infections for the period January through December 2013. Data were sought for all children <14 years of age.

Results. Four hundred and twenty-two episodes of S. aureus infection were identified. Three hundred and forty-two (81%) infections were caused by methicillin-susceptible S. aureus (MSSA) and 80 (19%) by methicillin-resistant S. aureus (MRSA). Clinical data were obtained for 286 (67.8%) cases, on which all further analyses were based. Clinical presentations for MSSA bacteraemia included skin and soft tissue infection (45%), pneumonia (10%), meningitis (6%), bone/joint infections (5%) and urinary tract infections (3%). Five (8.3%) cases of MRSA were community-acquired. Admission to intensive care unit (ICU) was the only risk factor associated with MRSA infection (adjusted odds ratio (aOR) 125.55; 95% confidence interval (CI) 11.67 - 1 350.68). Hospital-acquired S. aureus infection was the only factor associated with mortality on multivariate analysis (aOR 8.70; 95% CI 1.55 - 48.77).

Conclusion. S. aureus is frequently isolated in paediatric bacterial infections. Closer attention to infection control would impact on MRSA and S. aureus mortality rates in our setting.