Staphylococcus aureus Bacteremia in Pediatric Patients: Uncovering a Rural Health Challenge

Kyle J. Whittington, Sara M. Malone, Patrick G. Hogan, Faria Ahmed, Jessie Ann Flowers, Grace Milburn, John J. Morelli, Jason G. Newland, Stephanie A. Fritz

Research output: Contribution to journalArticlepeer-review


Background: Staphylococcus aureus bacteremia poses significant risk for morbidity and mortality. This may be exacerbated in rural populations facing unique health challenges. Methods: To investigate factors influencing S. aureus bacteremia outcomes, we conducted a retrospective cohort study of children admitted to St. Louis Children's Hospital (SLCH) from 2011 to 2019. Exposures included rurality (defined by the Rural-Urban Continuum Code), Area Deprivation Index, and outside hospital (OSH) admission before SLCH admission. The primary outcome was treatment failure, a composite of 90-day all-cause mortality and hospital readmission. Results: Of 251 patients, 69 (27%) were from rural areas; 28 (11%) were initially admitted to an OSH. Treatment failure occurred in 39 (16%) patients. Patients from rural areas were more likely to be infected with methicillin-resistant S. aureus (45%) vs urban children (29%; P =. 02). Children initially admitted to an OSH, vs those presenting directly to SLCH, were more likely to require intensive care unit-level (ICU) care (57% vs 29%; P =. 002), have an endovascular source of infection (32% vs 12%; P =. 004), have a longer duration of illness before hospital presentation (4.1 vs 3.0 days; P =. 04), and have delayed initiation of targeted antibiotic therapy (3.9 vs 2.6 days; P =. 01). Multivariable analysis revealed rural residence (adjusted odds ratio [aOR], 2.3; 95% CI, 1.1-5.0), comorbidities (aOR, 2.9; 95% CI, 1.3-6.2), and ICU admission (aOR, 3.9; 95% CI, 1.9-8.3) as predictors of treatment failure. Conclusions: Children from rural areas face barriers to specialized health care. These challenges may contribute to severe illness and worse outcomes among children with S. aureus bacteremia.

Original languageEnglish
Article numberofad296
Pages (from-to)S16-S20
JournalOpen Forum Infectious Diseases
Issue number7
StatePublished - Jul 1 2023


  • Area Deprivation Index
  • Rural-Urban Continuum Code
  • Staphylococcus aureus
  • bacteremia
  • rural health


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