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Updated: Aug 17, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Three-year surveillance of community-acquired Staphylococcus aureus infections in children
Sheldon L Kaplan1, Kristina G Hulten, Blanca E Gonzalez
1Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. skaplan@bcm.tmc.edu
Background:
Methicillin-resistant Staphylococcus aureus (MRSA) isolates are increasingly frequent causes of skin and soft-tissue infections or invasive infections in many communities.
Methods:
Prospective surveillance for community-acquired S. aureus infections at Texas Children's Hospital was initiated on 1 August 2001. Infections meeting the definition of community-acquired were identified. Demographic and clinical data were collected. Antibiotic susceptibilities, including inducible resistance to macrolide, lincosamide, and streptogramin B (MLSB), were determined in the clinical microbiology laboratory with the methodology of the NCCLS. All data were entered into a computer database. Data were analyzed by chi2 tests.
Results:
From 1 August 2001 to 31 July 2004, the percentage of community-acquired S. aureus isolates that were methicillin resistant increased from 71.5% (551 of 771 isolates) in year 1 to 76.4% (1193 of 1562 isolates) in year 3 (P = .008). The number of both community-acquired MRSA (CA-MSRA) isolates and community-acquired methicillin-susceptible S. aureus (CA-MSSA) isolates increased yearly, but the rate of increase was greater for the CA-MRSA isolates. Among the CA-MRSA isolates, 2542 (95.6%) were obtained from children with skin and soft-tissue infections, and 117 (4.4%) were obtained from children with invasive infections. Overall, 62% of children with CA-MRSA isolates and 53% of children with CA-MSSA isolates were admitted to the hospital (P = .0001). The rate of clindamycin resistance increased significantly for both CA-MRSA isolates (P = .003) and CA-MSSA isolates (P = .00003) over the 3 years. MLSB inducible resistance was found in 27 (44%) of 62 clindamycin-resistant CA-MSSA isolates, compared with 6 (4.5%) of 132 clindamycin-resistant CA-MRSA isolates (P < .000001).
Conclusions:
CA-MRSA isolates account for an increasing percentage and number of infections at Texas Children's Hospital. Clindamycin resistance increased among community-acquired S. aureus isolates. Community surveillance of community-acquired S. aureus infections is critical to determine the appropriate empiric antibiotic treatment for either local or invasive infections.
Insights
Community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are rising, with increasing clindamycin resistance observed in both MRSA and MSSA strains. Ongoing surveillance is vital for effective antibiotic treatment strategies.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) is a growing cause of community-acquired skin and soft-tissue infections, as well as invasive infections.
- Surveillance data from Texas Children's Hospital highlights the increasing prevalence of MRSA.
Purpose of the Study:
- To track the incidence and trends of community-acquired Staphylococcus aureus infections.
- To analyze antibiotic resistance patterns, particularly for MRSA and methicillin-susceptible S. aureus (MSSA).
- To assess clindamycin resistance and inducible macrolide-lincosamide-streptogramin B (MLSB) resistance in S. aureus isolates.
Main Methods:
- Prospective surveillance of community-acquired S. aureus infections from August 2001 to July 2004.
- Collection of demographic and clinical data, alongside antibiotic susceptibility testing.
- Analysis of data using chi-squared tests to determine statistical significance.
Main Results:
- The proportion of community-acquired S. aureus isolates that were methicillin-resistant increased from 71.5% to 76.4% over three years.
- Both CA-MRSA and CA-MSSA infections increased, but CA-MRSA showed a greater rate of increase.
- Clindamycin resistance significantly rose in both CA-MRSA and CA-MSSA isolates, with higher rates of inducible MLSB resistance in CA-MSSA.
Conclusions:
- Community-acquired MRSA infections are increasing in number and proportion at Texas Children's Hospital.
- Rising clindamycin resistance necessitates careful consideration for empiric antibiotic therapy.
- Continuous community surveillance of S. aureus infections is crucial for guiding appropriate treatment decisions.
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