Risk factors, antimicrobial susceptibility, and outcome of methicillin-resistant Staphylococcus aureus bacteremia in critically ill children with sepsis in a tertiary hospital in Egypt

Abstract

Background Staphylococcus aureus bacteremia (SAB) and methicillin-resistant Staphylococcus aureus (MRSA) infection are associated with unfavorable outcomes. Aim To reveal the risk factors, sensitivity to antibiotics, and outcome of MRSA bacteremia in infants and children with sepsis. Settings and design A prospective observational cross-sectional study was performed in Mansoura University Children’s Hospital from March 2023 to January 2024. Patients and methods The study involved infants and children diagnosed with sepsis and confirmed SAB on blood culture. Demographic data and blood culture with antibiotics sensitivity were recorded. Risk factors for MRSA bacteremia, antibiotic susceptibility, and mortality are the study outcomes. Statistical analysis used Multivariate analysis was done to assess the predictors of MRSA infection. Results A total of 319 patients were admitted with sepsis. SAB was isolated from 133 patients, 99 (74.4%) with methicillin-sensitive Staphylococcus aureus and 34 (25.6%) with MRSA. Risk factors for the development of MRSA infection are the presence of hospital-acquired infection (adjusted odds ratio=6.95), prolonged mechanical ventilation, presence of shock, and decreased body weight. Mortality was higher in the MRSA group (20.6 vs. 6.1%, P=0.014) with prolonged median duration of pediatric intensive care unit admission (19.5 vs. 14 days; P=0.040). Linezolid and teicoplanin were the most efficient antibiotics used in MRSA with 100% sensitivity in-vitro cultures, whereas resistance to erythromycin (90.9%) was documented. Conclusion MRSA poses a significant threat in pediatric sepsis. The presence of hospital-acquired infection and prolonged mechanical ventilation are the chief predictors of MRSA infection. Linezolid and teicoplanin are the most sensitive antibiotics used in MRSA management.