Clinical-Epidemiological Profile of Invasive Staphylococcus Aureus Infections in Hospitalized Pediatric Patients

Invasive Staphylococcus aureus (SA) infections are an important cause of morbidity and mortality in hospitalized children. Prompt, appropriate diagnosis and treatment are essential. Therefore, the hospital established a set of measures (a bundle) to improve disease management and reduce mortality and complications. The study aimed to describe the clinical-epidemiological profile of invasive SA infections in pediatric patients hospitalized at a public university hospital and to assess adherence to the institutional bundle. A retrospective study based on chart review of patients aged 0 to 17 years and 11 months with invasive SA infection diagnosed between January 2020 and December 2023. Community and nosocomial cases were included, with isolation in blood cultures or sterile materials and defined infectious focus such as bacteremia, sepsis, deep abscesses, or musculoskeletal infections. The institutional bundle included: follow-up blood cultures after 48 hours of antibiotics, source control, endocarditis evaluation, de-escalation to oxacillin, vancomycin dose adjustment based on serum levels, and treatment duration according to protocol. Fifty-five patients were included, with a median age of 5 years and length of stay of 30 days. Oxacillin-resistant SA infections occurred in 43.6% of cases. Overall mortality was 5.5%, occurring exclusively among patients with MSSA, suggesting association with severe comorbidities (p < 0.01). Adherence to the institutional management bundle was 82%. Mean antimicrobial use was 17 days, with vancomycin as the most frequently used agent. In 68.3% of cases, empiric antibiotics were appropriate, and vancomycin dose adjustments occurred in 73.3% of patients. Forty percent of total hospitalization time occurred in intensive care units. Switching to oral antibiotics enabling discharge occurred in six patients (10.9%). The institutional experience reinforces the need to optimize diagnosis and therapy of S. aureus infections through standardized protocols and a structured care pathway, even for oxacillin-susceptible microorganisms. The data highlight the importance of antimicrobial stewardship, early risk stratification, and continuous monitoring of clinical outcomes related to infections.