Staphylococcus aureus bloodstream infection at a referral children's hospital in Cape Town, South Africa, 2018 – 2022

Namushi, Jombo

Staphylococcus aureus bloodstream infection at a referral children's hospital in Cape Town, South Africa, 2018 – 2022

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Paediatrics and Child Health

Faculty

Faculty of Health Sciences

Abstract

Background: In the absence of a vaccine, Staphylococcus aureus (S. aureus) remains a major cause of morbidity and mortality in children. Studies describing S. aureus bloodstream infection (BSI) in children in Africa have reported variations in disease spectrum and trends over time and paediatric studies remain few. Objectives: To describe the recent epidemiology, clinical presentation, treatment, and outcome of S. aureus BSI in children at Red Cross War Memorial Children's Hospital (RCWMCH) during a five-year period, 2018 – 2022. Methods: This was a retrospective descriptive cohort study conducted at RCWMCH in Cape Town, South Africa. All S. aureus positive blood culture results for the period 2018-2022 on the National Health Laboratory Service (NHLS) microbiology database were identified. Case records of all positive cultures were retrieved. Demographic and clinical details, antimicrobial management and patient outcome data was extracted. Data was analysed using descriptive and inferential statistical methods. Continuous variables were presented as means and standard deviations or medians and interquartile ranges as appropriate. Categorical variables were summarised using proportions and percentages. Parametric (Student t-test) and non-parametric (Wilcoxon rank sum test for independent variables) methods were used to compare continuous variables. Pearson's Chi-square or Fisher exact test were used to compare categorical variables. RStudio statistical computing software version 4.4.2 was used for the logistic regression analysis. Results: During the 5-year study period, there were 243 S aureus BSIs, with an overall annual incidence risk of 2.6 cases per 1000 admissions. Methicillin-resistant S. aureus (MRSA) was the cause of 10% of BSIs and caused predominantly healthcare-associated infections (79.2%). 66.7% of methicillin-susceptible S. aureus (MSSA) episodes were community acquired. Only 2.1% of the participants were living with Human immunodeficiency virus (HIV). Healthcare-associated infection comprised 33.3% of all S. aureus BSIs. Most BSIs had an identifiable site of infection with skin and soft tissue being the commonest infection site. MRSA isolates were resistant to 71% (10/14) of the tested antibiotics. The 28-day mortality rate was 8.3%, and all occurred among MSSA infection episodes. The commonest attributable cause of death was septic shock (25%). Intensive care unit (ICU) admission during a BSI episode and unknown HIV status were significantly associated with increased risk of mortality within 28 days of S. aureus BSI diagnosis. Conclusions: S. aureus BSI remains a major cause of morbidity and mortality in children. At RCWMCH there has been a decline in the incidence of S. aureus BSI and the proportion of MRSA infections. Admission to ICU during a BSI episode and unknown HIV status were significantly associated with 28-day mortality.

Keywords

Staphylococcus aureus

bloodstream infection

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