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Community-acquired methicillin-resistant Staphylococcus aureus infections: hospitalization and case fatality risk in
Ángela Gentile1, Julia Bakir2, Gabriela Ensinck3
1Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires. angelagentile21@gmail.com.
Introduction:
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are prevalent both in Argentina and worldwide, and they may have a severe clinical course.
Objectives:
To estimate the hospitalization rate and case fatality risk factors of CA-MRSA infection.
Methods:
Cross-sectional, analytical study. All patients < 15 years old with community-acquired Staphylococcus aureus (CA-SA) infections admitted to 10 pediatric facilities between January 2012 and December 2014 were included.
Results:
Out of 1141 patients with CA-SA, 904 (79.2%) had CA-MRSA. The rate of hospitalization of CA-MRSA cases (per 10 000 discharges) among patients < 5 years old was 27.6 in 2012, 35.2 in 2013, and 42.7 in 2014 (p = 0.0002). The 2-4-year-old group was the most affected one: 32.2, 49.4, and 54.4, respectively (p = 0.0057). The clinical presentations included skin and soft tissue infections: 66.2%, pneumonia: 11.5%, sepsis/bacteremia: 8.5%, osteomyelitis: 5.5%, arthritis: 5.2%, psoas abscess: 1.0%, pericarditis/endocarditis: 0.8%, meningitis: 0.6%, and other: 0.7%. In terms of antibiotic resistance, 11.1% had resistance to erythromycin; 8.4%, to gentamicin; and 0.6%, to trimethoprim-sulfamethoxazole. All strains were susceptible to vancomycin. The case fatality rate was 2.2% and associated risk factors were (odds ratio [95% confidence interval]) age > 8 years (2.78, 1.05-7.37), pneumonia (6.37, 2.3717.09), meningitis (19.53, 2.40-127.87), and sepsis/bacteremia (39.65, 11.94-145.55).
Conclusions:
The rate of CA-MRSA infection was high; the rate of hospitalization increased in the 2013-2014 period; the 2-4-year-old group was the most affected one. A higher case fatality risk was observed among patients > 8 years old and those with the clinical presentations of pneumonia, meningitis, and sepsis.
Insights
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are common in children, with increasing hospitalization rates observed. Risk factors for severe outcomes include pneumonia, meningitis, and sepsis, particularly in older children.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Antimicrobial resistance
Background:
- Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections pose a significant global health challenge.
- These infections can lead to severe clinical outcomes in pediatric populations.
Purpose of the Study:
- To determine the hospitalization rates of CA-MRSA infections in children under 15.
- To identify risk factors associated with case fatality in pediatric CA-MRSA cases.
Main Methods:
- A cross-sectional, analytical study was conducted.
- Data were collected from 10 pediatric facilities between January 2012 and December 2014.
- Included were all patients under 15 years old diagnosed with community-acquired Staphylococcus aureus (CA-SA) infections.
Main Results:
- CA-MRSA accounted for 79.2% of all CA-SA infections (904 out of 1141 patients).
- Hospitalization rates for CA-MRSA increased significantly from 2012 to 2014, especially in the 2-4-year-old age group.
- The case fatality rate was 2.2%, with higher risks linked to pneumonia, meningitis, sepsis/bacteremia, and age over 8 years.
Conclusions:
- CA-MRSA infections are highly prevalent in children, with a notable rise in hospitalizations.
- Young children (2-4 years) are most affected, while older children (>8 years) face increased mortality risk.
- Pneumonia, meningitis, and sepsis are critical indicators of severe CA-MRSA infection outcomes.
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