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PEDIATRICS Vol. 113 No. 4 April 2004, pp. e347-e352

ELECTRONIC ARTICLE

Community-Acquired Methicillin-Resistant Staphylococcus aureus in Southern New England Children

Dinusha W. Dietrich, MD*, Dianne B. Auld, MT (ASCP), CLS{ddagger} and Leonard A. Mermel, DO, ScM§

* Division of Pediatric Infectious Diseases, Department of Pediatrics
§ Division of Infectious Diseases, Department of Medicine, Brown Medical School and Rhode Island Hospital, Providence, Rhode Island
{ddagger} Microbiology Laboratory, Rhode Island Hospital, Providence, Rhode Island

Objective. This study was performed to understand the epidemiology of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in southern New England children.

Methods. A retrospective review was conducted of the medical records of children 0 to 18 years old with MRSA isolated by the Rhode Island Hospital microbiology laboratory (Providence, RI) between 1997 and 2001. A case was classified as either health care-associated MRSA (HCA-MRSA) or CA-MRSA based on time of culture and other strict criteria. The spectrum of illness of the HCA-MRSA and CA-MRSA cases was compared, as were the antibiotic-susceptibility patterns of their isolates. Risk factors for CA-MRSA acquisition were identified, and molecular subtyping of selected isolates was performed.

Results. Between 1997 and 2001, S aureus was isolated from 1063 children. Of these children, 57 had MRSA. During this period, both the absolute number of MRSA cases and the proportion of S aureus cases due to MRSA rose more than threefold due to increases in both CA-MRSA and HCA-MRSA infections. Of the 57 MRSA cases, 23 (40%) were CA-MRSA. CA-MRSA patients were more likely to have skin/soft-tissue infections than HCA-MRSA patients (83% vs 38%). Risk factors for acquisition of MRSA including intrafamilial spread, frequent antibiotic exposure, and child-care attendance were identified in 8 of the 23 (35%) CA-MRSA patients. CA-MRSA isolates were more likely to be susceptible to non-ß-lactam antibiotics than HCA-MRSA isolates. All isolates were vancomycin susceptible.

Conclusions. MRSA accounts for an increasing proportion of all pediatric S aureus infections in southern New England. A significant percentage of these cases are due to CA-MRSA. Pediatricians should have heightened suspicion for CA-MRSA in children with presumed S aureus infections, especially if they have skin/soft-tissue infections or risk factors for MRSA acquisition.

Key Words: methicillin resistance • Staphylococcus aureus; community acquired • New England • children

Abbreviations: MRSA, methicillin-resistant Staphylococcus aureus • CA, community-acquired • HCA, health care-associated • SCC, staphylococcal chromosomal cassette

Received for publication Jun 23, 2003; Accepted Dec 1, 2003.


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