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) ≥ 20 mg/dl [OR 4.2, 95% CI 1.16-15.25] and hemoglobin nadir ≤ 9 g/dl [OR 5.2, 95% CI 1.3-20.64]. Conclusions In addition to MRSA infection, CRP ≥ 20 mg/dl and hemoglobin nadir ≤ 9 g/dl were associated with VTE in SA bacteremia. These factors may serve as markers for increased risk of VTE with invasive SA disease.