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Epidemiology of methicillin-resistant Staphylococcus aureus at a children's hospital
Andrew L Campbell1, Kristina A Bryant, Beth Stover
1Kosair Children's Hospital, University of Louisville, Louisville, Kentucky 40204, USA.
Objective:
To describe the relative contribution of and risk factors for both community-acquired and nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections.
Design:
Retrospective cohort study.
Setting:
270-bed, tertiary-care children's hospital.
Participants:
All MRSA-infected children from whom MRSA was recovered between October 1, 1999, and September 30, 2001.
Methods:
Demographic, clinical, and risk factor data were abstracted from medical records. Categorical variables were analyzed using the chi-square or Fisher's exact test and continuous variables were analyzed using the Mann-Whitney test.
Results:
Of the 62 patients with new MRSA infection, 37 had community-acquired MRSA and 25 had nosocomial MRSA. Most community-acquired MRSA infections were of the skin and soft tissue, the middle ear, and the lower respiratory tract. Nosocomial MRSA infections occurred in the lower respiratory tract, the skin and soft tissue, and the blood. Risk factors for infection, including underlying medical illness, prior hospitalization, and prior surgery, were similar for patients with community-acquired MRSA and nosocomial MRSA. History of central venous catheterization and previous endotracheal intubation was more common in patients with nosocomial MRSA. Only 3 patients with community-acquired MRSA had no identifiable risk factor other than recent antibiotic use. Resistance for clindamycin, erythromycin, and levofloxacin was similar between strains of community-acquired MRSA and nosocomial MRSA.
Conclusions:
Similarities in patient risk factors and resistance patterns of isolates of both community-acquired and nosocomial MRSA suggest healthcare acquisition of most MRSA. Thus, classifying MRSA as either community acquired or nosocomial underestimates the amount of healthcare-associated MRSA.
Insights
Most methicillin-resistant Staphylococcus aureus (MRSA) infections in children, whether community-acquired or hospital-acquired, likely stem from healthcare exposure. Similar risk factors and resistance patterns highlight the need to recognize broader healthcare-associated risks.
Area of Science:
- Infectious Diseases
- Pediatric Medicine
- Clinical Microbiology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen in both community and healthcare settings.
- Understanding the distinct origins and risk factors of community-acquired MRSA (CA-MRSA) versus nosocomial MRSA (N-MRSA) is crucial for effective infection control.
- Previous studies have explored MRSA epidemiology, but a direct comparison of risk factors and characteristics in a pediatric tertiary-care setting is warranted.
Purpose of the Study:
- To delineate the relative contributions of community-acquired and nosocomial MRSA infections in a pediatric population.
- To identify and compare risk factors associated with both types of MRSA infections.
- To analyze antimicrobial resistance patterns for both community-acquired and nosocomial MRSA isolates.
Main Methods:
- Retrospective cohort study design.
- Inclusion of all pediatric patients with MRSA infection from October 1999 to September 2001 at a tertiary-care children's hospital.
- Analysis of demographic, clinical, and risk factor data using chi-square, Fisher's exact, and Mann-Whitney tests.
Main Results:
- Out of 62 patients, 37 had community-acquired MRSA and 25 had nosocomial MRSA.
- Common sites for community-acquired MRSA included skin/soft tissue, middle ear, and lower respiratory tract; nosocomial MRSA frequently affected the lower respiratory tract, skin/soft tissue, and blood.
- Risk factors like underlying illness, prior hospitalization, and surgery were similar for both groups, though central venous catheterization and intubation were more common in nosocomial cases. Antimicrobial resistance patterns were comparable.
Conclusions:
- The overlap in patient risk factors and isolate resistance suggests that most MRSA infections in this pediatric cohort are healthcare-associated.
- Classifying MRSA solely as community-acquired or nosocomial may underestimate the true burden of healthcare-associated MRSA.
- This finding emphasizes the importance of comprehensive infection prevention strategies across all healthcare interactions.