Management of serious <i>Staphylococcus aureus</i> infections in children: A survey of paediatric infectious diseases physicians in Canada

Abstract Objectives Staphylococcus aureus (SA) infections are a common problem in children and a frequent reason for paediatric infectious diseases (PID) consultation. We sought to describe contemporary practices of Canadian PID physicians for management of serious paediatric SA infections. Methods We developed and disseminated a national, self-administered, cross-sectional online survey of Canadian PID consultants to assess practice patterns involving the management of serious paediatric SA infections. Results Thirty-nine of 84 (46%) PID consultants across 14 Canadian children's hospitals completed the survey; 48.7% (n = 19) had been practising for 10 or more years and 92.1% (n = 35) completed their PID training in Canada. For methicillin sensitive SA (MSSA) infections outside the central nervous system, 56.4% (n = 22) of respondents preferred cefazolin. Ceftriaxone/cefotaxime was used as definitive treatment for MSSA by 26.3% (n = 10). Prescribing penicillin for penicillin sensitive SA was divided with 51.3% (n = 20) choosing to use it. Most respondents chose to treat SA bacteremia (SAB) with no focus in immunocompetent children and neonates for 14 days, 89.7% (n = 35) and 92.3% (n = 36), respectively. Variability was observed in the practices of ordering abdominal ultrasounds and echocardiograms for SAB with no focus, and in the transition to oral antibiotics for MSSA bacteremia. Variability was also noted in treating osteoarticular infections with methicillin resistant SA bacteremia, with 56.4% (n = 22) choosing intravenous antibiotics until an appropriate clinical response is observed while others advised a minimum 7 (17.9%, n = 7) or 14 (12.8%, n = 5) day intravenous course. Conclusion Our study highlights both areas of consistency and variability among Canadian PID physicians in managing serious SA infections in children, emphasizing the need for evidence-based paediatric guidelines and increased inclusion of children in clinical trials.