Treatment of Staphylococcus aureus Bacteremia in Children: Is Intravenous Therapy Always Needed?

BACKGROUND: Traditionally, prolonged courses of intravenous antibiotics have been recommended to treat Staphylococcus aureus bacteremia. However, this approach can be associated with catheter-related complications and can be costly. The purpose of our study was to describe the treatment regimens and outcomes of children with S. aureus bacteremia. METHODS: We conducted a single center retrospective cohort study over a 5-year period including all children ≤18 years hospitalized with S. aureus bacteremia. We excluded children with polymicrobial bloodstream infections and with incomplete records. We compared baseline characteristics and clinical outcomes between those treated with intravenous (IV)-only antibiotics, >7 days IV course followed by oral antibiotics (LongIV+PO) and <7 days IV course followed by oral switch (ShortIV+PO), using Pearson’s chi-squared test to compare dichotomous variables. RESULTS: We identified 314 episodes of S. aureus bacteremia. Most (59.9%) received IV-only regimen, 61/314 (19.4%) were treated with LongIV+PO and 65/314 (20.7%) treated with ShortIV+PO. The mean age was 4.2 years for those treated with the IV-only regimen compared with 6.7 years and 8.3 years for children treated with LongIV+PO and ShortIV+PO regimens respectively. Catheter-related infections were more frequently treated with IV-only (85% IV-only; 9% LongIV+PO; 6% ShortIV+PO), as was pneumonia (61% IV-only; 28% LongIV+PO; 11% ShortIV+PO), whereas musculoskeletal infections (25.6% IV-only; 29.5% LongIV+PO; 44.9% ShortIV+PO), and skin/soft-tissue infections (35% IV-only; 27.5% LongIV+PO; 37.5% ShortIV+PO) were more commonly treated with a short IV course. Recurrence of infection within 30 days occurred in 5/176 (2.8%) of those in the IV-only regimen, in 1/60 (1.7%) who received the LongIV+PO regimen, and in 2/63 (3.2%) of those in the ShortIV+PO regimen (P = 0.85). CONCLUSION: In this cohort study of children with S. aureus bacteremia, most were treated with IV-only course, while 40% were transitioned to an oral regimen after either a short or long IV course. Infections arising from a skin/soft tissue or musculoskeletal source were more likely to be transitioned to a PO regimen. Recurrence rates in the antibiotic route regimen groups were similar. DISCLOSURES: T. Zaoutis, Astellas: Consultant, Consulting fee; Merck: Grant Investigator, Research grant; nabriva: Consultant, Consulting fee