(784) Epidemiology of Staphylococcus aureus Infections in Pediatric Critical Care Patients

Introduction: Epidemiologic studies of pediatric staphylococcal infections are outdated and broad, offering limited information about the burden of critical illness-associated Staphylococcus aureus infections in the pediatric intensive care unit (PICU). We aimed to evaluate the complexity and costs associated with S. aureus infections among PICU patients to provide insight into the potential impact of S. aureus vaccination and other mitigation measures.

Methods: We conducted a retrospective cohort study of children < 18 years old admitted to non-neonatal U.S. PICUs using the Healthcare Cost and Utilization Project’s State Inpatient Databases from 21 U.S. states in 2001, 2004, 2010, 2016, and 2019. We extracted patient and hospitalization characteristics and used ICD-9/10-CM codes to identify diagnoses, organ failures, and procedures.

Results: Of 196,873 PICU admissions, 5,337 (2.7%) included a diagnosis of S. aureus infection. The prevalence of S. aureus infections in the PICU rose from 2.6% in 2001 to a peak of 3.4% in 2016, then fell to 2.3% by 2019. PICU patients with S. aureus infections had higher rates of multiple organ dysfunction (MODS; 37.8% vs. 15.3% of PICU patients without S. aureus infections, p< 0.01) and mechanical ventilation (45.7% vs 17.1%, p< 0.01), longer mean (±SD) hospital length of stay (LOS; 25.1 ±38.4 days vs. 7.8 ±15.0 days, p< 0.01), and higher mortality (3.7% vs. 2.0%, p< 0.01). The most common sites of S. aureus infection were skin & soft tissue (57.3% of infections) and respiratory tract (19.2%), and 35.2% were methicillin-resistant S. aureus. Between 2001-2019, the prevalence of MODS among critically ill children with S. aureus infection increased from 20.0% to 50.6%, while mortality fell from 6.1% to 3.5% (p < 0.01). In 2019, hospitalization costs associated with S. aureus infections in the PICU were over three times higher than PICU hospitalizations without S. aureus infection ($124,800 ±$252,000 vs. $36,700 ±$102,200, p< 0.01).

Conclusions: The cost and complexity of PICU patients with S. aureus infections are substantially higher than PICU patients without S. aureus. Interventions to mitigate the frequency and severity of S. aureus infections would result in important reductions in PICU morbidity, mortality, and resource use.