Published online June 2, 2008
PEDIATRICS Vol. 121 No. 6 June 2008, pp. 1090-1098 (doi:10.1542/peds.2007-2104)
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ARTICLE

Prevalence of and Risk Factors for Community-Acquired Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Colonization in Children Seen in a Practice-Based Research Network

Stephanie A. Fritz, MDa, Jane Garbutt, MB, ChBa,b, Alexis Elward, MD, MPHa, William Shannon, PhDb,c and Gregory A. Storch, MDa,b

Departments of a Pediatrics
b Medicine
c Division of Biostatistics, Washington University School of Medicine, St Louis, Missouri

OBJECTIVE. We sought to define the prevalence of and risk factors for methicillin-resistant Staphylococcus aureus nasal colonization in the St Louis pediatric population.

METHODS. Children from birth to 18 years of age presenting for sick and well visits were recruited from pediatric practices affiliated with a practice-based research network. Nasal swabs were obtained, and a questionnaire was administered.

RESULTS. We enrolled 1300 participants from 11 practices. The prevalence of methicillin-resistant S aureus nasal colonization varied according to practice, from 0% to 9% (mean: 2.6%). The estimated population prevalence of methicillin-resistant S aureus nasal colonization for the 2 main counties of the St Louis metropolitan area was 2.4%. Of the 32 methicillin-resistant S aureus isolates, 9 (28%) were health care-associated types and 21 (66%) were community-acquired types. A significantly greater number of children with community-acquired methicillin-resistant S aureus were black and were enrolled in Medicaid, in comparison with children colonized with health care-associated methicillin-resistant S aureus. Children with both types of methicillin-resistant S aureus colonization had increased contact with health care, compared with children without colonization. Methicillin-sensitive S aureus nasal colonization ranged from 9% to 31% among practices (mean: 24%). The estimated population prevalence of methicillin-sensitive S aureus was 24.6%. Risk factors associated with methicillin-sensitive S aureus colonization included pet ownership, fingernail biting, and sports participation.

CONCLUSIONS. Methicillin-resistant S aureus colonization is widespread among children in our community and includes strains associated with health care-associated and community-acquired infections.

Key Words: community-acquired Staphylococcus aureus • methicillin resistance • practice-based research network

Abbreviations: MRSA—methicillin-resistant Staphylococcus aureus • CA—community-acquired • HA—health care-associated • SCCmec—staphylococcal cassette chromosome mec • PVL—Panton-Valentine leukocidin • MSSA—methicillin-sensitive Staphylococcus aureus • CI—confidence interval • OR—odds ratio • PFGE—pulsed-field gel electrophoresis

Accepted Oct 4, 2007.


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