S. aureus infections in hospitalized children with hematological, hepatological or kidney diseases over a 16-year period at a tertiary care hospital in Sweden: a retrospective observational study

Background Staphylococcus aureus (S. aureus) continues to be a significant pathogen responsible for a wide spectrum of infections with potentially fatal outcomes. The existing literature on S. aureus infection in children is still limited and highly heterogeneous, making it difficult to establish standardized indicators for complicated infections—especially in children with underlying medical conditions. Within this study we describe the clinical course and outcome of S. aureus infections in hospitalized pediatric patients with significant underlying disease or risk factors and assess whether clinical and/or laboratory features may be associated with the infectious course. Methods Patients receiving inpatient care for S. aureus infection at the Karolinska University Hospital Huddinge, Sweden were identified by ICD-coding. Infection frequency, clinical course, underlying disease and medication were reviewed. Events were grouped according to severity (mild versus complicated) and subgroup analysis was performed. Results Between 01/2004 and 12/2019, 38 patients with proven inpatient S. aureus infection were identified. These patients displayed a high number of recurrence accounting for a total number of 68 S. aureus infection episodes. All patients had significant underlying co-morbidities and risk factors. In 58 episodes (85.3%) an indwelling device was present. No S. aureus related mortality occurred and sequelae were extremely rare. Patients with complicated infection were more likely to display fever and elevated CRP at presentation, while leukocyte and neutrophil numbers did not significantly differ. Outpatient care prior to infection, local infection signs and a good or excellent status at presentation were associated with mild infection in our cohort. Conclusions Recurrent infections were frequent among affected patients. Prompt antibiotic treatment upon suspicion of infection as well as the removal of indwelling devices may have contributed to the overall favorable outcomes in our cohort. Further studies are required to address the usefulness of identified variables to guide clinical decision making.