Factors associated with disease severity in hospitalized children with <i>Staphylococcus aureus</i> infection

Staphylococcus aureus is a common cause of serious infections in children, with the incidence of methicillin-resistant Staphylococcus aureus (MRSA) rising in recent decades. To identify the factors associated with disease severity in pediatric patients hospitalized with S. aureus infection in high-complexity institutions in Santander, Colombia. A cross-sectional study was conducted among children under 18 years of age with S. aureus infection who were hospitalized (2018-21). Clinical characteristics and outcomes were compared between MRSA and methicillin-susceptible Staphylococcus aureus (MSSA) infections. Factors associated with severity were identified through multivariate analysis with logistic and binomial regression. One hundred fifty-four cases of S. aureus infection were included, with 75 (48.7%) being MRSA. Among community-acquired infections, 55.7% (44/79) were caused by MRSA. Pediatric intensive care unit (PICU) admission was required in 55.8% of cases, and the infection-attributable case-fatality rate (CFR) was 1.9%. MRSA infections were associated with a greater need for vasopressor/inotropic support (prevalence ratio [PR], 2.06; 95% confidence interval [CI], 1.05-4.04; P = .036). Persistent bacteremia was associated with an increased PICU admission (PR 1.72; 95%CI: 1.19-2.46), mechanical ventilation (PR 8.63; 95%CI: 3.16-23.54), and vasopressor/inotropic support (PR 11.06; 95%CI: 4.59-26.58). S. aureus infections showed a high prevalence of MRSA, with a notable proportion of community-acquired cases. More than half required admission to PICU, but the infection-attributable CFR was low. MRSA infections and persistent bacteremia were associated with disease severity. These findings support the use of timely antibiotic therapy and reinforce the need for infection prevention and control strategies.