Table 3.
Selected characteristics of children with Staphylococcus aureus bloodstream infection and vancomycin MICs of 2 μg/ml, Alfred I. DuPont Hospital for Children, 1 April 2000 to 31 March 2008
| Characteristica | MSSA (n = 9) | MRSA (n = 7) | P value |
|---|---|---|---|
| Age, median (range) | 8 mo (0–11 yr) | 3 mo (0–12 yr) | 0.4 |
| Male sex (n [%]) | 5 (56) | 4 (57) | 0.5 |
| Underlying condition (n) | |||
| Prematurity | 4 | ||
| Endocarditis | 1 | ||
| Osteomyelitis | 2 | 2 | |
| Leukemia, HLH | 4 | ||
| TPN dependent | 2 | ||
| Tracheostomy | 1 | ||
| Previous vancomycin exposure (n [%])b | 3 (33) | 3 (43) | |
| Sepsis (n) | 2 | 2 | |
| Central venous access (n) | 8 | 7 | |
| Empirical antibiotic therapyc (n) | |||
| Vancomycin | 2 | ||
| Vancomycin + β-lactamd | 5 | 1 | |
| Vancomycin + aminoglycoside | 2 | ||
| Vancomycin + clindamycin | 1 | ||
| Vancomycin + rifampin | 1 | ||
| β-Lactam + clindamycin | 1 | ||
| Clindamycin | 1 | ||
| β-Lactam | 2 | ||
| Days of bacteremia, mean (range) | 2.67 (1–6) | 2.29 (1–3) | 0.4 |
| Definitive antibiotic therapye (n) | |||
| Vancomycin alone | 1 | 5 | |
| Vancomycin + β-lactam | 1 | ||
| Vancomycin + rifampin | 1 | ||
| β-Lactam | 5 | - | |
| β-Lactam + rifampin | 1 | ||
| β-Lactam + aminoglycoside | 1 | ||
| Linezolid | 1 | ||
| Duration of therapy (mean [range]) (days) | 26 (1–42) | 17 (4–42) | 0.3 |
| Mortalityf (n) | 1g | 0 | 0.5 |
HLH, hemophagocytic lymphohistiocytosis; TPN, total parenteral nutrition. n, number of children with characteristic.
Patients with previous vancomycin exposure, measured as doses of vancomycin administered, 6 months prior to the documented S. aureus infection.
Antibiotic agents given pending culture reports.
β-Lactam antibiotics included oxacillin, nafcillin, cefazolin, cefepime, cefotaxime, ceftriaxone, and piperacillin-tazobactam.
Antibiotic therapy given based on identification and susceptibility report.
Attributable mortality.
Patient on hospice care admitted with sepsis and orders to not resuscitate.