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Endemic, multiply resistant Staphylococcus aureus in a pediatric population. Clinical description and risk factors
1Veterans Administration Medical Center, Asheville, NC 28805.
Insights
Multiply resistant Staphylococcus aureus (MRSA) infections in children led to longer hospital stays and more procedures. MRSA pneumonia had a high mortality rate, highlighting the severity of these pediatric infections.
Area of Science:
- Pediatric Infectious Diseases
- Hospital-Acquired Infections
- Antimicrobial Resistance
Background:
- Multiply resistant Staphylococcus aureus (MRSA) poses a significant threat in pediatric healthcare settings.
- Understanding the epidemiology and clinical impact of MRSA in children is crucial for effective management.
Purpose of the Study:
- To investigate the incidence, types of infections, and clinical outcomes of pediatric patients acquiring MRSA.
- To identify risk factors and patient characteristics associated with MRSA infection in a hospital setting.
Main Methods:
- Retrospective analysis of pediatric patients admitted over a seven-year period.
- Multivariate analysis comparing MRSA-infected patients with matched control subjects.
- Documentation of infection types, colonization status, and patient outcomes.
Main Results:
- 38 children acquired MRSA, with 20 developing 23 infectious episodes.
- Infections ranged from endocarditis and pneumonia to wound infections and sepsis.
- MRSA patients had longer hospitalizations, more surgeries, and increased need for tracheostomy.
- MRSA pneumonia demonstrated a high mortality rate (38%).
Conclusions:
- Pediatric MRSA acquisition is associated with severe clinical outcomes and increased resource utilization.
- MRSA poses a substantial risk for serious infections, particularly pneumonia, in hospitalized children.
- Continued surveillance and infection control measures are essential to mitigate MRSA burden in pediatric populations.
Abstract:
During a seven-year period, 38 children acquired multiply resistant Staphylococcus aureus (MRSA) after admission to a pediatric service. Eighteen children were thought to be colonized. Twenty-three infectious episodes occurred in the remaining 20 children. Infections included endocarditis (n = 2), pneumonia (n = 8), burn infection (n = 1), postoperative wound infection (n = 6), intra-abdominal abscess (n = 1), catheter sepsis (n = 2), urinary tract infection (n = 1), conjunctivitis (n = 1), and central nervous system shunt infection (n = 1). When patients infected with MRSA were compared by multivariate analysis with control subjects matched for age and unit of admission, patients with MRSA were hospitalized longer, underwent more surgical procedures, received more intravenous alimentation, and were more likely to require a tracheostomy; no correlation was found with administration of antibiotics. Twenty-six of the 34 discharged patients remained colonized with MRSA. Mortality in the infected patients was 20% (4/20), with a 38% (3/8) mortality rate for MRSA pneumonia.