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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 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
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.

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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

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

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