Clinical features and outcomes of children with staphylococcus aureus bacteraemia at Tygerberg Hospital

Thesis (MBChB)--Stellenbosch University, 2021.ENGLISH ABSTRACT: Background: Staphylococcus aureus is thought to be an important cause of pneumonia, neonatal sepsis as well as Staphylococcus aureus bacteraemia. In Africa, the epidemiology and the aetiology of paediatric blood stream infections are poorly documented. Methods: A retrospective study was conducted at Tygerberg Hospital in Cape Town, South Africa, to investigate the clinical features, foci of infection, treatment and outcomes of neonates and children treated for Staphylococcus aureus bacteraemia over a period of 2.5 years. Results: Over a period of 2.5 years, 138 episodes of S. aureus bacteraemia were identified of which 56.5% were in neonates and 43.5% were from the paediatric service. MRSA was responsible for 42.7% of the episodes. 63.7% of the S. aureus bacteraemia episodes were hospital associated infections and 96.6% of the MRSA bacteraemia episodes were also hospital associated infections. Previous ICU admission (p=0.00), duration of hospitalisation (p=0.00), preterm gestation (p=0.00), low birthweight (p=0.00), indwelling intravascular device (p=0.03), age (p=0.00), HIV infection (p=0.03), were associated with an increased risk for MRSA bacteraemia on univariate analysis. Bone and joint infections, skin and soft tissue infections and bacteraemia with no source were the most common source of infection in MSSA bacteraemia. Bacteraemia with no source was the most common presentation in MRSA bacteraemia. There were 24 deaths recorded over the study period of which 79.2% were directly attributed to S. aureus bacteraemia. Factors significantly associated with death on multivariate analysis include MRSA bacteraemia (p=0.01) and admission to the ICU (p=0.04). In addition to these findings, specific neonatal risk factors for death were birthweight (p=0.02), age at the time of the positive blood culture (p