Epidemiologie von Staphylococcus aureus-Bakteriämien im Kindesalter – “säkulare Trends”

Zusammenfassung

Staphylococcus aureus ist aufgrund der Häufigkeit, Virulenz und Antibiotikaresistenzentwicklung ein wichtiger Erreger von Bakteriämien im Kindesalter. In den letzten 10 Jahren sind S. aureus-Bakteriämie (SAB)-Inzidenzzahlen zwischen 8,4 und 105 pro 100 000 Kinder publiziert worden. Die höchsten Inzidenzen werden im Säuglingsalter beobachtet. Ein eindeutiger Trend über Anstieg oder Abfall der Inzidenzzahlen ist nicht auszumachen. Die meisten SAB, vor allem im Säuglingsalter, sind im Krankenhaus erworben. Eine chronische Grunderkrankung oder zentrale Venenkatheter als Risikofaktoren weisen die meisten Kinder mit SAB auf und die Zahl dieser Patienten ist steigend. Die meisten Patienten mit SAB präsentieren sich mit einem klinischen Fokus. Die Letalität der SAB ist in den letzten 10 Jahren gesunken. Bakteriämien mit Methicillin-resistenten Staphylokokken gewinnen auch im Kindesalter zunehmend an Bedeutung.

Summary

Due to their frequency, virulence and potential development of antibiotic resistance, Staphylococcus aureus are a key cause of bacteremia in children. Over the last decade, published reports have documented S. aureus bacteremia (SAB) incidence rates to have been between 8.4 and 105 per 100 000 children, with the highest incidence rates being observed among infants, and with most SAB cases, especially among infants, being hospital-acquired. In this time period, epidemiological studies have documented no clear trend showing an increase or decrease in incidence rates. Among children with SAB, a majority has an underlying medical condition or a central venous catheter, both of which are known risk factors for SAB – and the number of these cases is increasing, even while overall SAB mortality has declined during the last 10 years. Most pediatric SAB cases present with a clinical focus. Bacteremia with methicillin- resistant staphylococci has been reported with increasing frequency among pediatric patients.

Schlüsselwörter

Staphylococcus aureus - Bakteriämie - epidemiologische Trends

Keywords

Staphylococcus aureus - bacteremia - epidemiological trends

• Literatur

• 1 Banerjee SN, Emori TG, Culver DH. et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980–1989. National Nosocomial Infections Surveillance System. Am J Med 1991; 91: 86S-89S.
• 2 Benfield T, Espersen F, Frimodt-Møller N. et al. Increasing incidence but decreasing in-hospital mortality of adult Staphylococcus aureus bacteraemia between 1981 and 2000. Clin Microbiol Infect 2007; 13: 257-263.
• 3 Berner R, Schumacher RF, Bartelt S. et al. Predisposing conditions and pathogens in bacteremia in hospitalized children. Eur J Clin Microbiol Infect Dis 1998; 17: 337-340.
• 4 Denniston S, Riordan FA. Staphylococcus aureus bacteraemia in children and neonates: a 10 year retrospective review. J Infect 2006; 53: 387-393.
• 5 Frederiksen MS, Espersen F, Frimodt-Møller N. et al. Changing epidemiology of pediatric Staphylococcus aureus bacteremia in Denmark from 1971 through 2000. Pediatr Infect Dis J 2007; 26: 398-405.
• 6 Hakim H, Mylotte JM, Faden H. Morbidity and mortality of Staphylococcal bacteremia in children. Am J Infect Control 2007; 35: 102-105.
• 7 Hill PC, Wong CG, Voss LM. et al. Prospective study of 125 cases of Staphylococcus aureus bacteremia in children in New Zealand. Pediatr Infect Dis J 2001; 20: 868-873.
• 8 Hufnagel M, Burger A, Bartelt S. et al. Secular trends in pediatric bloodstream infections over a 20-year period at a tertiary care hospital in Germany. Eur J Pediatr. 2008 (in press).
• 9 Jacobsson G, Dashti S, Wahlberg T, Andersson R. The epidemiology of and risk factors for invasive Staphylococcus aureus infections in western Sweden. Scand J Infect Dis 2007; 39: 6-13.
• 10 Khairulddin N, Bishop L, Lamagni TL. et al. Emergence of methicillin resistant Staphylococcus aureus (MRSA) bacteraemia among children in England and Wales, 1990–2001. Arch Dis Child 2004; 89: 378-379.
• 11 Labandeira-Rey M, Couzon F, Boisset S. et al. Staphylococcus aureus Panton-Valentine leukocidin causes necrotizing pneumonia. Science 2007; 315: 1130-1133.
• 12 Ladhani S, Konana OS, Mwarumba S, English MC. Bacteraemia due to Staphylococcus aureus . Arch Dis Child 2004; 89: 568-571.
• 13 Lowy FD. Staphylococcus aureus infections. N Engl J Med 1998; 339: 520-532.
• 14 Malanoski GJ, Samore MH, Pefanis A, Karchmer AW. Staphylococcus aureus catheter-associated bacteremia. Minimal effective therapy and unusual infectious complications associated with arterial sheath catheters. Arch Intern Med 1995; 155: 1161-1166.
• 15 Miles F, Voss L, Segedin E, Anderson BJ. Review of Staphylococcus aureus infections requiring admission to a paediatric intensive care unit. Arch Dis Child 2005; 90: 1274-1278.
• 16 Raad II, Sabbagh MF. Optimal duration of therapy for catheter-related Staphylococcus aureus bacteremia: a study of 55 cases and review. Clin Infect Dis 1992; 14: 75-82.
• 17 Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Pediatrics 1999; 103: e39.
• 18 Shorr AF, Tabak YP, Killian AD. et al. Healthcareassociated bloodstream infection: A distinct entity? Insights from a large U.S. database. Crit Care Med 2006; 34: 2588-2595.
• 19 Skinner D, Keefer CS. Significance of bacteremia caused by Staphylococcus aureus: A study of one hundred and twenty-two cases and a review of the literature concerned with experimental infection in animals. Arch Intern Med 1941; 68: 851-859.
• 20 Steinberg JP, Clark CC, Hackman BO. Nosocomial and community-acquired Staphylococcus aureus bacteremias from 1980 to 1993. Clin Infect Dis 1996; 23: 255-259.
• 21 Suryati BA, Watson M. Staphylococcus aureus bacteraemia in children: a 5-year retrospective review. J Paediatr Child Health 2002; 38: 290-294.
• 22 Valente AM, Jain R, Scheurer M. et al. Frequency of infective endocarditis among infants and children with Staphylococcus aureus bacteremia. Pediatrics 2005; 115: e15-e19.
• 23 von Eiff C, Becker K, Machka K. et al. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med 2001; 344: 11-16.