A more than 10-fold increase in methicillin-resistantStaphylococcus aureus (MRSA) infections drove a surge in pediatric Staphylococcus-associated hospitalizations that peaked in 2006, according to an analysis of 25 years of pediatric hospital discharge data in California. The study, published online December 12 in Emerging Infectious Diseases, found that children hospitalized for staphylococcal infections had longer hospital stays and higher mortality risk than children hospitalized for other causes.
Kathleen Gutierrez, MD, associate professor, Stanford University School of Medicine, California, and colleagues examined the hospital discharge data from 1985 to 2009 for 140,265 children and found that the number of staphylococcal infections rose from 49 per 100,000 children to a peak of 83 per 100,000 children in 2006 before falling to 73 per 100,000 in 2009. The records came from the California Office of Statewide Health Planning and Development, which maintains a hospital discharge database.
MRSA and cellulitis drove the increase in staphylococcal infections: From 2000 to 2009, MRSA-related hospitalizations increased from 3 per 100,000 to 35 per 100,000 children, with MRSA cellulitis making up 46% of the MRSA-related hospitalizations, MRSA pneumonia making up 6%, and MRSA septicemia making up 4.5%.
Mean length-of-stay (LOS) also increased in peak infection years, from 17.3 days to 26.7 days between 1985 and 2002; by 2009, the mean fell again to 17.7 days.
Among non-neonates, children with hospital-onset (HO) infections were at the highest risk for death from staphylococcal infection. Only 5 in 100,000 children had an HO infection; however, 7.5% of those infections were fatal. The LOS was also longest at 40.7 days (median, 28 days). Twenty infections per 100,000 children were community onset (CO), and 20 per 100,000 were community-onset, healthcare-associated (CO-HCA) infections. Children with CO-HCA infections died 2% of the time, with a mean LOS of 13.6 days (median, 8 days). Children with CO infections had the lowest fatality rate, at less than 0.1%, with a mean LOS of 5.3 days (median, 4 days).
Children younger than 3 years, black children, boys, and children without private insurance had the highest incidence of hospitalization with staphylococcal infection. The researchers found black children were 1.5 times more likely to be hospitalized for a staphylococcal infection than white children, and Asian children were 0.6 times less likely to be hospitalized compared with white children. Black and Asian children had the highest mortality percentage, at 2.9%, compared with 2.3% for white children and 2.4% for Hispanic children.
Lack of Insurance Cited
Lack of insurance was the most predictive factor in increasing risk for staphylococcal infection among hospitalized children (odds ratio [OR], 1.3). By comparison, race was associated with an OR of 1.05 for black children, an OR of 0.96 for Hispanic children, and an OR of 1.0 for Asian children compared with white children.
Children without private insurance also had slightly longer LOS (median, 8 days) than those with insurance (median, 7 days).
Children younger than 1 year were most likely to be hospitalized, at a rate of 452 children hospitalized per 100,000 children. Neonates (infants <30 days old) made up 25% of the entire infected population with an OR for infection of 5.64 (95% confidence interval [CI], 5.55 - 5.73) compared with a reference group of children aged between 1 and 2 years. Some 4.5% of neonates died, the highest percentage of fatalities in all age categories.
The median hospital stay among all children was 7 days, with stays ranging up to 2067 days. In 10% of cases, children remained hospitalized less than 60 days. Neonates had longest LOS, with a median of 28 days.
Sixty-five percent of the children hospitalized for 3 months or longer were neonates hospitalized within 2 days of birth, even though neonates made up just 16% of the infected population.
When neonates were removed from calculations, staphylococcus remained a primary driver of LOS. Excluding neonates, children hospitalized for staphylococcal infections stayed in the hospital longer than children hospitalized for any other reason (median LOS for staphylococcal-infected children was 6 days [mean, 13.9] compared with 2 days [mean, 4.9] for all other causes).
Children with a staphylococcal infection were more likely to die than those hospitalized for any other diagnosis (OR, 2.1; 95% CI, 2.0% - 2.2%) after controlling for year of admission, LOS, age at admission, sex, race, and insurance status. The infection was fatal in 2.5% of children, but most (82.6%) had a routine discharge. Another 10.4% required low- to medium-intensity care on discharge, and 4.4% were transferred to another acute-care facility. Over the study period, risk for death increased for children hospitalized with staphylococcal infections, going from 2.4% in 1985 to 3.5% in 2002 and then falling again in 2003 and remaining below 2% from 2006 to 2009.
The authors have disclosed no relevant financial relationships.
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