Infection Control & Hospital Epidemiology (2018), 39, 1487–1490 doi:10.1017/ice.2018.259


Concise Communication


Epidemiology of Staphylococcus aureus infections in patients admitted to freestanding pediatric hospitals, 2009–2016


Alicen B. Spaulding PhD, MPH1, Cary Thurm PhD2, Joshua D. Courter PharmD3, Ritu Banerjee MD, PhD4, Jeffrey S. Gerber MD5, Jason G. Newland MD6, Sarah K. Parker MD7, Thomas V. Brogan MD8, Matthew P. Kronman MD9, Samir S. Shah MD, MSCE10, Michael J. Smith MD11, Sameer J. Patel MD, MPH12, Brian R. Lee PhD13 and


Adam L. Hersh MD PhD14 1Children’s Minnesota Research Institute, Minneapolis, Minnesota, 2Children’s Hospital Association, Lenexa, Kansas, 3Division of Pharmacy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, 4Division of Pediatrics Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, 5Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, 6Division of Pediatric Infectious Diseases, School of Medicine, Washington University, St Louis, Missouri, 7Division of Pediatric Infectious Diseases, Children’s Hospital Colorado and University of Colorado, Aurora, Colorado, 8Pediatric Critical Care Medicine, Seattle Children’s Hospital, School of Medicine, University of Washington, Seattle, Washington, 9Division of Infectious Diseases, Seattle Children’s Hospital, School of Medicine, University of Washington, Seattle, Washington, 10Division of Hospital Medicine, Cincinnati Children’s Hospital Medical


Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, 11Division of Pediatric Infectious Diseases, Duke University, Durham, North Carolina, 12Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, 13Division of Infectious Diseases, Children’sMercy Hospital, Kansas City, Missouri and 14Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah.


Abstract


We observed pediatric S. aureus hospitalizations decreased 36% from 26.3 to 16.8 infections per 1,000 admissions from 2009 to 2016, with methicillin-resistant S. aureus (MRSA) decreasing by 52% and methicillin-susceptible S. aureus decreasing by 17%, among 39 pediatric hospitals. Similar decreases were observed for days of therapy of anti-MRSA antibiotics.


(Received 14 May 2018; accepted 9 September 2018; electronically published October 29, 2018)


Staphylococcus aureus (S. aureus) causes a substantial number of pediatric infections each year in the United States, with potential for severe complications including death.1–4 Although the emer- gence of methicillin-resistant S. aureus (MRSA) led to a rapid increase in the number of S. aureus infections in children,5 recent data suggest that S. aureus infections are declining in adults, driven primarily by decreases in MRSA.6,7 Similar findings have been reported in pediatric populations, but these studies were limited to single centers and unique populations, such as military members or infants.4,5,8–10 A nationally representative and con- temporary characterization of epidemiologic trends in S. aureus infections has not been conducted. The objective of this study was to describe recent trends in pediatric S. aureus hospitalizations and associated antibiotic prescribing patterns.


Patients and Methods Data source and quality


We conducted a retrospective cohort study using the Pediatric Health Information Systems (PHIS) administrative database,


Author for correspondence: Alicen Burns Spaulding, PhD, MPH, Children’s Min-


nesota Research Institute, 2525 Chicago Ave. S. MS 40–460, Minneapolis, MN 55404. E-mail: Alicen.Spaulding@childrensmn.org


Cite this article: Spaulding AB, et al. (2018). Epidemiology of Staphylococcus aureus


infections in patients admitted to freestanding pediatric hospitals, 2009–2016. Infection Control & Hospital Epidemiology 2018, 39, 1487–1490. doi: 10.1017/ice.2018.259


© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.


maintained by the Children’s Hospital Association (Overland Park, KS). PHIS includes clinical and resource utilization data from inpatient, emergency, ambulatory surgery, and observation units at more than 45 tertiary-care freestanding children’s hos- pitals in the United States. The data are subject to numerous validity and reliability checks before incorporation into the database. The data warehouse function was provided by Truven Health Analytics (Ann Arbor, MI).


Study population


All inpatient encounters for patients <18 years of age hospitalized between January 1, 2009, and December 31, 2016, at a PHIS hospital with continuous reporting were included. The study population was limited to patients with an S. aureus infection indicated in the electronic medical record, defined as (1) having ≥1 International Classification of Disease, Clinical Modifications version 9 or version 10 discharge code for MRSA (038.12, 041.12, 482.42, A41.02, A49.02, B95.62, J152.12, V02.54) or methicillin- susceptible S. aureus (MSSA) (038.11, 041.11, 482.41, A41.01, A49.01, B95.61, J152.11, V02.53) present on admission or occurring during the admission; and (2) receiving ≥1 anti- staphylococcal antibiotic (list available upon request). Using additional discharge codes when present, S. aureus infections were further stratified into 4 infection categories: (1) skin or soft- tissue infection (SSTI); (2) myositis/osteomyelitis/septic arthritis;


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