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Updated: Dec 17, 2025
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Community-Acquired Methicillin-Resistant Staphylococcus aureus Infections in Acutely Ill Children: A Retrospective
Saptharishi Lalgudi Ganesan1,2,3,4, Ankit Mehta4, Keshavmurthy Lakshmikantha4
1Children's Hospital of Western Ontario, London Health Sciences Center, London, Canada.
Objectives:
To test if admission clinical and laboratory variables could reliably discriminate community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections from methicillin-sensitive Staphylococcus aureus (MSSA) infections in acutely ill children, and to describe the epidemiology, clinical features and outcomes among children with Staphylococcal infections admitted to the hospital.
Methods:
The authors conducted this retrospective case-control study comparing children with CA-MRSA and MSSA infections admitted to hospital between June 2014 and June 2017. They describe the evolving epidemiology and attempt to identify clinical and laboratory variables that can differentiate MRSA cases from MSSA controls. They used multivariate logistic regression to identify independent predictors of MRSA infection and Cox-proportional hazard analysis to compare survival times.
Results:
Seventy-three children were enrolled, of which 35 had CA-MRSA and 38 had MSSA infections. Children in MRSA group were younger [median (IQR) age in months: 36 (12, 62) vs. 56 (37, 96); p = 0.032]. MRSA and MSSA groups had similar rate of skin and soft tissue involvement (SSTI) [62.9% vs. 54.1%; p = 0.449]. Median duration of illness was lower in MRSA, 6 vs. 8.5 d (p = 0.001). TLC of 8100 or less was 82% sensitive and 94% specific for MRSA sepsis at admission [AUROC = 0.64 (0.51-0.77), p = 0.04]. Mortality (8.6% vs. 10.5% p = 1.0) and length of ICU stay (7.2 vs. 9.3 d, p = 0.24) were similar in both. None of the admission variables were predictive of MRSA culture-positivity on regression analysis.
Conclusions:
The hospital-based incidence of CA-MRSA infections among children appears to be increasing. None of the admission clinical or laboratory variables could reliably identify CA-MRSA infections. As there seems to be no reliable way to differentiate children with MSSA and MRSA infections, physicians may consider empiric initiation of broad-spectrum antibiotics at admission to cover both MSSA and MRSA, especially in critically ill children with suspected Staphylococcal infections.
Insights
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is increasing in children. Admission variables cannot reliably distinguish CA-MRSA from methicillin-sensitive Staphylococcus aureus (MSSA) infections. Empiric broad-spectrum antibiotics may be needed for critically ill children.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a growing concern in pediatric populations.
- Differentiating CA-MRSA from methicillin-sensitive Staphylococcus aureus (MSSA) infections in acutely ill children is clinically challenging.
- Understanding the epidemiology and clinical features of Staphylococcal infections in hospitalized children is crucial for effective management.
Purpose of the Study:
- To determine if initial clinical and laboratory findings can reliably differentiate CA-MRSA from MSSA infections in hospitalized children.
- To describe the epidemiology, clinical presentation, and outcomes of pediatric Staphylococcal infections.
- To identify predictors of CA-MRSA infection in this cohort.
Main Methods:
- A retrospective case-control study comparing children with CA-MRSA and MSSA infections from June 2014 to June 2017.
- Analysis of demographic, clinical, and laboratory variables at admission.
- Multivariate logistic regression and Cox-proportional hazard analysis were used to identify predictors and compare survival.
Main Results:
- The study included 73 children (35 CA-MRSA, 38 MSSA). CA-MRSA patients were younger (median 36 vs. 56 months).
- Skin and soft tissue involvement rates were similar. CA-MRSA infections had a shorter median illness duration (6 vs. 8.5 days).
- A total white blood cell count ≤8100 was 82% sensitive and 94% specific for MRSA sepsis. No admission variables predicted MRSA positivity on regression analysis. Mortality and ICU stay were similar.
Conclusions:
- The incidence of CA-MRSA infections in hospitalized children appears to be rising.
- No reliable clinical or laboratory markers at admission can differentiate CA-MRSA from MSSA infections in children.
- Empiric broad-spectrum antibiotic coverage for both MSSA and MRSA is recommended for critically ill children with suspected Staphylococcal infections.
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