Outcomes of Pediatric Patients With Sepsis Related to Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus Infections Requiring Extracorporeal Life Support: An ELSO Database Study.

Cortney Foster,Peter Rycus,Adrian Holloway,Jason Custer,Adnan Bhutta,Jenni Day,Dayanand Bagdure

doi:10.3389/fped.2021.706638

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is increasingly utilized for pediatric sepsis unresponsive to steroids and inotropic support. Outcomes of children with sepsis are influenced by the type of pathogen causing their illness.Objective: To determine if the outcomes of children with Staphylococcus aureus sepsis receiving ECMO differed according to microbial sensitivity (Methicillin-resistant Staphylococcus aureus [MRSA] vs. Methicillin-sensitive Staphylococcus aureus [MSSA]).Methods: Retrospective case-matched cohort study of children (0–<18 years) with Staphylococcus aureus sepsis reported to the ELSO registry from more than 995 centers. Inclusion criteria were age 0–18 years, laboratory diagnosis of Staphylococcal infection, clinical diagnosis of sepsis, and ECMO deployment. Exclusion criteria were no laboratory diagnosis of Staphylococcal infection. We compared patient demographics, pre-ECMO management and outcomes of those with MRSA vs. MSSA using Chi-Square test, with independent samples t-test used to test to compare continuous variables.Results: In our study cohort of 308 patients, 160 (52%) had MSSA and 148 (48%) MRSA with an overall survival rate of 41.5%. There were no differences in the age group (p = 0.76), gender distribution (p = 0.1) or racial distribution (p = 0.58) between the two groups. P value for racial distribution should be 0.058. There were 91 (56.8%) deaths in the MSSA group and 89 (60.1%) deaths (p = 0.56) in the MRSA group. Duration on ECMO (p = 0.085) and the time from intubation to ECMO (p = 0.37) were also similar in the two groups. Survival with MSSA sepsis and MRSA sepsis did not improve significantly over the 20 years evaluated despite an increase in ECMO utilization.Conclusion: In this multi-center retrospective study, there were no differences in outcomes for children receiving ECMO support with Staphylococcus aureus sepsis according to microbial methicillin sensitivity. There was no significant increase in survival among patients with MRSA and MSSA infections receiving ECMO in the last 20 years.

Highlights

Severe sepsis and septic shock remain leading causes of pediatric mortality globally [1]
Staphylococcus aureus is a common cause of sepsis and septic shock in the pediatric population
There was a mean mortality rate of 9% in the methicillin sensitive Staphylococcus aureus (MSSA) group compared to 20.9% in the Methicillin-resistant Staphylococcus aureus (MRSA) group [6]

Summary

Introduction

Severe sepsis and septic shock remain leading causes of pediatric mortality globally [1]. The majority of children who die of sepsis experience multiorgan dysfunction and refractory shock and often do so within the first 72 h of their hospital admission [4]. Staphylococcus aureus is a common cause of sepsis and septic shock in the pediatric population. Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent pathogen with high mortality [5]. A metaanalysis of the differences in mortality between pediatric patients with MRSA and methicillin sensitive Staphylococcus aureus (MSSA) bacteremia found a significantly higher mortality risk (OR = 2.33) in patients with MRSA bacteremia than in those with MSSA bacteremia. Outcomes of children with sepsis are influenced by the type of pathogen causing their illness

Methods

Results

Conclusion