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TABLE 3

Univariable Analyses of Risk Factors Associated With Treatment Failure Among Children With MRSA Bacteremia

Treatment Failure
 n/N (%)OR (95% CI)P
Institution   .06 
 A 42/110 (38.2) Ref  
 B 18/65 (27.1) 0.65 (0.32–1.2)  
 C 12/57 (21.1) 0.61 (0.21–0.91)  
Sex   .33 
 Girl 27/98 (27.6) Ref  
 Boy 45/134 (31.0) 1.33 (0.75–2.35)  
Race   .07 
 Non–African American 38/142 (26.8) Ref  
 African American 33/86 (38.4) 1.7 (0.96–3.01)  
Ethnicity   .14 
 Non-Hispanic 52/163 (31.9) Ref  
 Hispanic 4/24 (16.7) 0.43 (0.14–1.31)  
Insurance   .35 
 Private or self-pay 43/127 (33.9) Ref  
 Public 29/103 (28.2) 0.76 (0.44–1.35)  
Epidemiological category   .23 
 Community-onset 60/182 (33.0) Ref  
 Hospital-onset 12/50 (24.0) 0.64 (0.31–1.32)  
Comorbid condition at baseline   .03 
 None 42/111 (37.8) Ref  
 Yes (any) 30/121 (25.8) 0.54 (0.31–0.95)  
Indwelling device   .03 
 None 55/148 (37.2) Ref  
 Central venous catheter 11/57 (19.3) 0.40 (0.19–0.84)  
 Other indwelling device 6/27 (22.2) 0.48 (0.18–1.27)  
Primary source   .003 
 Catheter-relateda 10/52 (19.2) Ref  
 Musculoskeletalb 36/83 (43.4) 3.21 (1.42–7.27)  
 Skin/soft tissue 9/42 (21.4) 1.15 (0.42–3.14)  
 Pneumonia 7/21 (33.3) 2.1 (0.67–6.56)  
 Endovasculara 7/11 (63.6) 7.35 (1.80–30.1)  
 No source 1/11 (9.1) 0.42 (0.05–3.67)  
 Other 2/12 (16.7) 0.84 (0.15–4.45)  
Time until anti-MRSA antibiotic   .84 
 0–1 d 68/218 (31.2) Ref  
 ≥2 d 4/14 (28.6) 0.88 (0.27–2.91)  
Treated with vancomycin plus additional anti-MRSA antibiotic in the first 48 h   .02 
 No (vancomycin alone) 32/119 (27) Ref  
 Yes 37/86 (43) 2.05 (1.14–3.70)  
Critical illnessa   .06 
 No 62/212 (29.5) Ref  
 Yes 10/20 (50.0) 2.42 (0.96–6.10)  
Initial vancomycin dose   .56 
 <50 mg/kg/d 41/117 (35.0) Ref  
 ≥50 mg/kg/d 20/65 (30.8) 0.82 (0.43–1.58)  
First vancomycin serum trougha,c   .72 
 <5 μg/mL 22/58 (37.9) Ref  
 5 to <10 μg/mL 25/69 (36.2) 0.94 (0.46–1.92)  
 10 to <15 μg/mL 9/28 (32.1) 0.81 (0.34–1.97)  
 ≥15 μg/mL 4/17 (23.5) 0.71 (0.24–2.09)  
Vancomycin MICd   .24 
 MIC ≤ 1 μg/mL 62/198 (31.3) Ref  
 MIC = 2 μg/mL 3/17 (17.7) 0.47  
Source control interventiona    
 None needed 13/46 (28.3) Ref .85 
 Within 3 d 29/95 (30.5) 1.11 (0.51–2.42)  
 Delayed (>3 d) 30/91 (33.0) 1.25 (0.57–2.71)  
Treatment Failure
 n/N (%)OR (95% CI)P
Institution   .06 
 A 42/110 (38.2) Ref  
 B 18/65 (27.1) 0.65 (0.32–1.2)  
 C 12/57 (21.1) 0.61 (0.21–0.91)  
Sex   .33 
 Girl 27/98 (27.6) Ref  
 Boy 45/134 (31.0) 1.33 (0.75–2.35)  
Race   .07 
 Non–African American 38/142 (26.8) Ref  
 African American 33/86 (38.4) 1.7 (0.96–3.01)  
Ethnicity   .14 
 Non-Hispanic 52/163 (31.9) Ref  
 Hispanic 4/24 (16.7) 0.43 (0.14–1.31)  
Insurance   .35 
 Private or self-pay 43/127 (33.9) Ref  
 Public 29/103 (28.2) 0.76 (0.44–1.35)  
Epidemiological category   .23 
 Community-onset 60/182 (33.0) Ref  
 Hospital-onset 12/50 (24.0) 0.64 (0.31–1.32)  
Comorbid condition at baseline   .03 
 None 42/111 (37.8) Ref  
 Yes (any) 30/121 (25.8) 0.54 (0.31–0.95)  
Indwelling device   .03 
 None 55/148 (37.2) Ref  
 Central venous catheter 11/57 (19.3) 0.40 (0.19–0.84)  
 Other indwelling device 6/27 (22.2) 0.48 (0.18–1.27)  
Primary source   .003 
 Catheter-relateda 10/52 (19.2) Ref  
 Musculoskeletalb 36/83 (43.4) 3.21 (1.42–7.27)  
 Skin/soft tissue 9/42 (21.4) 1.15 (0.42–3.14)  
 Pneumonia 7/21 (33.3) 2.1 (0.67–6.56)  
 Endovasculara 7/11 (63.6) 7.35 (1.80–30.1)  
 No source 1/11 (9.1) 0.42 (0.05–3.67)  
 Other 2/12 (16.7) 0.84 (0.15–4.45)  
Time until anti-MRSA antibiotic   .84 
 0–1 d 68/218 (31.2) Ref  
 ≥2 d 4/14 (28.6) 0.88 (0.27–2.91)  
Treated with vancomycin plus additional anti-MRSA antibiotic in the first 48 h   .02 
 No (vancomycin alone) 32/119 (27) Ref  
 Yes 37/86 (43) 2.05 (1.14–3.70)  
Critical illnessa   .06 
 No 62/212 (29.5) Ref  
 Yes 10/20 (50.0) 2.42 (0.96–6.10)  
Initial vancomycin dose   .56 
 <50 mg/kg/d 41/117 (35.0) Ref  
 ≥50 mg/kg/d 20/65 (30.8) 0.82 (0.43–1.58)  
First vancomycin serum trougha,c   .72 
 <5 μg/mL 22/58 (37.9) Ref  
 5 to <10 μg/mL 25/69 (36.2) 0.94 (0.46–1.92)  
 10 to <15 μg/mL 9/28 (32.1) 0.81 (0.34–1.97)  
 ≥15 μg/mL 4/17 (23.5) 0.71 (0.24–2.09)  
Vancomycin MICd   .24 
 MIC ≤ 1 μg/mL 62/198 (31.3) Ref  
 MIC = 2 μg/mL 3/17 (17.7) 0.47  
Source control interventiona    
 None needed 13/46 (28.3) Ref .85 
 Within 3 d 29/95 (30.5) 1.11 (0.51–2.42)  
 Delayed (>3 d) 30/91 (33.0) 1.25 (0.57–2.71)  

Ref, reference.

a

Variables selected a priori for inclusion in multivariate logistic regression model.

b

Including osteomyelitis, septic arthritis, and pyomyositis.

c

A first serum trough of >10 μg/mL compared with <10 μg/mL was our a priori–determined cutoff that we hypothesized may convey risk for treatment failure.

d

Excluding data unknown for 17 isolates; a sensitivity analysis assuming MIC <1 and then MIC >1 for the 17 unknown isolates also found no significant association between MIC and treatment failure.

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