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Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk
B C Herold1, L C Immergluck, M C Maranan
1Department of Pediatrics, The University of Chicago Hospitals, Ill 60637, USA.
Context:
Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections in children have occurred primarily in individuals with recognized predisposing risks. Community-acquired MRSA infections in the absence of identified risk factors have been reported infrequently.
Objectives:
To determine whether community-acquired MRSA infections in children with no identified predisposing risks are increasing and to define the spectrum of disease associated with MRSA isolation.
Design:
Retrospective review of medical records.
Patients:
Hospitalized children with S aureus isolated between August 1988 and July 1990 (1988-1990) and between August 1993 and July 1995 (1993-1995).
Setting:
The University of Chicago Children's Hospital.
Main Outcome Measures:
Prevalence of community-acquired MRSA over time, infecting vs colonizing isolates, and risk factors for disease.
Results:
The number of children hospitalized with community-acquired MRSA disease increased from 8 in 1988-1990 to 35 in 1993-1995. Moreover, the prevalence of community-acquired MRSA without identified risk increased from 10 per 100000 admissions in 1988-1990 to 259 per 100000 admissions in 1993-1995 (P<.001), and a greater proportion of isolates produced clinical infection. The clinical syndromes associated with MRSA in children without identified risk were similar to those associated with community-acquired methicillin-susceptible S aureus. Notably, 7 (70%) of 10 community-acquired MRSA isolates obtained from children with an identified risk were nonsusceptible to at least 2 drugs, compared with only 6 (24%) of 25 isolates obtained from children without an identified risk (P=.02).
Conclusions:
These findings demonstrate that the prevalence of community-acquired MRSA among children without identified risk factors is increasing.
Insights
Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections in children are rising, even in those without known risk factors. This increase highlights a growing public health concern for pediatric infectious diseases.
Area of Science:
- Pediatric Infectious Diseases
- Bacterial Pathogenesis
- Epidemiology of Staphylococcus aureus
Background:
- Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections in children typically occur in those with identifiable predisposing risks.
- Infrequent reports exist of community-acquired MRSA infections in children lacking recognized risk factors.
Purpose of the Study:
- To investigate the increasing incidence of community-acquired MRSA infections in children without identified risk factors.
- To characterize the spectrum of disease associated with MRSA isolation in pediatric populations.
Main Methods:
- A retrospective review of medical records was conducted.
- Data were collected from hospitalized children with Staphylococcus aureus isolates between August 1988-July 1990 and August 1993-July 1995 at The University of Chicago Children's Hospital.
- Key outcomes included the prevalence of community-acquired MRSA over time, distinction between infecting and colonizing isolates, and identification of risk factors for disease.
Main Results:
- Hospitalizations for community-acquired MRSA disease in children increased significantly from 8 (1988-1990) to 35 (1993-1995).
- The prevalence of community-acquired MRSA without identified risk rose from 10 to 259 per 100,000 admissions (P<.001), with a higher proportion causing clinical infection.
- Clinical syndromes in children without risk factors were similar to those with methicillin-susceptible S. aureus, but MRSA isolates from children with risk factors showed higher rates of multi-drug non-susceptibility (70% vs. 24%, P=.02).
Conclusions:
- The prevalence of community-acquired MRSA among pediatric patients lacking identified risk factors is demonstrably increasing.
- This trend necessitates further investigation into the evolving epidemiology and management of MRSA in children.