Clinical variables and Staphylococcus aureus virulence factors associated with venous thromboembolism in children.
OBJECTIVES: Children with Staphylococcus aureus (SA) bacteremia risk developing venous thromboembolism (VTE). We sought to identify clinical variables and bacterial virulence factors associated with VTE in SA bacteremia.
STUDY DESIGN: This is a single-institution retrospective study of 229 children with SA bacteremia hospitalized from 2005 to 2008. Clinical data were abstracted from patient charts. Two-hundred three SA isolates were analyzed by polymerase chain reaction. The Pediatric Health Information System (PHIS) database was queried to identify subjects with a central venous line (CVL) or complex chronic conditions (CCC). Logistic regression analysis was employed to determine which factors most greatly influenced VTE.
RESULTS: VTE was present in 9.2% (n=21/229). Superficial thrombi were excluded. Mortality was greater in patients with VTE [24% vs. 6% (p=0.016)]. Among SA isolates available for virulence testing, the majority (70%; n=139) were methicillin-sensitive SA (MSSA). Methicillin-resistant SA (MRSA) infection was associated with VTE (p=0.01). The most common sites of thrombosis were extremity deep vein (58%; n=14/24), head/neck (29%; n=7), and visceral (13%; n=3). One subject had a pulmonary embolism. The presence of a CVL or a CCC was not associated with VTE. Independent predictors of VTE were C-reactive protein (CRP)≥20mg/dl [OR 4.2, 95% CI 1.16-15.25] and hemoglobin nadir ≤9g/dl [OR 5.2, 95% CI 1.3-20.64].
CONCLUSIONS: In addition to MRSA infection, CRP≥20mg/dl and hemoglobin nadir ≤9g/dl were associated with VTE in SA bacteremia. These factors may serve as markers for increased risk of VTE with invasive SA disease.
Adolescent; Bacteremia; C-Reactive Protein; Child; Child, Preschool; Female; Hemoglobins; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Retrospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Venous Thromboembolism; Virulence Factors
Children; Teenagers; Anemia; Bacteremia; CRP; Thrombosis; VTE; Virulence factors; Staph Infection
Carpenter, Shannon L.; Goldman, Jennifer; Sherman, Ashley K.; Bell, J Jeremiah; Selveraju, Suresh; Newland, Jason G.; Jarka, Dale E.; Chastain, Katherine; and Selvarangan, Rangaraj, "Clinical variables and Staphylococcus aureus virulence factors associated with venous thromboembolism in children." (2016). Manuscripts, Articles, Book Chapters and Other Papers. 333.