Abstract
Aims: To investigate the epidemiological and clinical aspects of MRSA among inpatients and outpatients presenting to hospital.
Methods: Analysis of demographic, epidemiological, and clinical data collected on 385 children first identified as having MRSA between January 1998 and December 2003 in a 250 bed English children's hospital.
Results: There were 267 inpatients and 118 outpatients. The number of new cases of MRSA declined from 72 in 1998 to 52 in 2003, whereas hospital activity increased. Ninety nine (37.1%) inpatients acquired MRSA outside the hospital; a further 90 occurred among 31 clusters of cases. One hundred and seventy eight (66.7%) inpatients were aged <2 years; cardiac services and paediatric & neonatal surgery accounted for 59.6% of cases. Dermatology and A&E accounted for 51.7% of outpatients; 73.8% of outpatients had recently previously attended the hospital. A total of 13.9% of inpatients with MRSA developed bacteraemia; MRSA accounted for 15% of Staphylococcus aureus bacteraemias. The risk of MRSA bacteraemia in colonised patients, and the proportion of S aureus bacteraemias that were MRSA, varied between specialties. Intravascular devices were the most common source of MRSA bacteraemia (63.4% of cases). The mortality rate was 7.3%.
Conclusions: Enhanced surveillance of MRSA can identify at-risk patient groups, thus facilitating targeting of control measures. The absence of a link between numbers of cases of acquisition of MRSA and bacteraemia suggests that the rise in MRSA bacteraemia may not solely reflect an increase in MRSA prevalence in children in the UK. The need for larger epidemiological studies is emphasised.
Full Text
The Full Text of this article is available as a PDF (63.1 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Buckingham Steven C., McDougal Linda K., Cathey Lorene D., Comeaux Katha, Craig Allen S., Fridkin Scott K., Tenover Fred C. Emergence of community-associated methicillin-resistant Staphylococcus aureus at a Memphis, Tennessee Children's Hospital. Pediatr Infect Dis J. 2004 Jul;23(7):619–624. doi: 10.1097/01.inf.0000131981.67342.c4. [DOI] [PubMed] [Google Scholar]
- Campbell Andrew L., Bryant Kristina A., Stover Beth, Marshall Gary S. Epidemiology of methicillin-resistant Staphylococcus aureus at a children's hospital. Infect Control Hosp Epidemiol. 2003 Jun;24(6):427–430. doi: 10.1086/502226. [DOI] [PubMed] [Google Scholar]
- Dietrich Dinusha W., Auld Dianne B., Mermel Leonard A. Community-acquired methicillin-resistant Staphylococcus aureus in southern New England children. Pediatrics. 2004 Apr;113(4):e347–e352. doi: 10.1542/peds.113.4.e347. [DOI] [PubMed] [Google Scholar]
- Eady E. Anne, Cove Jonathan H. Staphylococcal resistance revisited: community-acquired methicillin resistant Staphylococcus aureus--an emerging problem for the management of skin and soft tissue infections. Curr Opin Infect Dis. 2003 Apr;16(2):103–124. doi: 10.1097/00001432-200304000-00007. [DOI] [PubMed] [Google Scholar]
- Gray J. W. MRSA: the problem reaches paediatrics. Arch Dis Child. 2004 Apr;89(4):297–298. doi: 10.1136/adc.2003.045534. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gray James W. A 7-year study of bloodstream infections in an English children's hospital. Eur J Pediatr. 2004 Jul 6;163(9):530–535. doi: 10.1007/s00431-004-1489-7. [DOI] [PubMed] [Google Scholar]
- Hancox R., Cummins A., Kelsey M. C. An outbreak of EMRSA 2 associated with long-term colonization of medical staff. J Hosp Infect. 1992 Oct;22(2):170–172. doi: 10.1016/0195-6701(92)90104-t. [DOI] [PubMed] [Google Scholar]
- Hill P. C., Wong C. G., Voss L. M., Taylor S. L., Pottumarthy S., Drinkovic D., Morris A. J. Prospective study of 125 cases of Staphylococcus aureus bacteremia in children in New Zealand. Pediatr Infect Dis J. 2001 Sep;20(9):868–873. doi: 10.1097/00006454-200109000-00009. [DOI] [PubMed] [Google Scholar]
- Khairulddin N., Bishop L., Lamagni T. L., Sharland M., Duckworth G. Emergence of methicillin resistant Staphylococcus aureus (MRSA) bacteraemia among children in England and Wales, 1990-2001. Arch Dis Child. 2004 Apr;89(4):378–379. doi: 10.1136/adc.2003.028712. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Melzer M., Eykyn S. J., Gransden W. R., Chinn S. Is methicillin-resistant Staphylococcus aureus more virulent than methicillin-susceptible S. aureus? A comparative cohort study of British patients with nosocomial infection and bacteremia. Clin Infect Dis. 2003 Nov 6;37(11):1453–1460. doi: 10.1086/379321. [DOI] [PubMed] [Google Scholar]
- Shanson D. C. Antibiotic-resistant Staphylococcus aureus. J Hosp Infect. 1981 Mar;2(1):11–36. doi: 10.1016/0195-6701(81)90003-7. [DOI] [PubMed] [Google Scholar]
- Suryati B. A., Watson M. Staphylococcus aureus bacteraemia in children: a 5-year retrospective review. J Paediatr Child Health. 2002 Jun;38(3):290–294. doi: 10.1046/j.1440-1754.2002.00787.x. [DOI] [PubMed] [Google Scholar]
- Warshawsky B., Hussain Z., Gregson D. B., Alder R., Austin M., Bruckschwaiger D., Chagla A. H., Daley J., Duhaime C., McGhie K. Hospital- and community-based surveillance of methicillin-resistant Staphylococcus aureus: previous hospitalization is the major risk factor. Infect Control Hosp Epidemiol. 2000 Nov;21(11):724–727. doi: 10.1086/501718. [DOI] [PubMed] [Google Scholar]
- White Caroline. MRSA infections rose by 5% between 2003 and 2004. BMJ. 2004 Jul 17;329(7458):131–131. doi: 10.1136/bmj.329.7458.131-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
- van Saene H. K. F., Weir W. I., de la Cal M. A., Silvestri L., Petros A. J., Barrett S. P. MRSA--time for a more pragmatic approach? J Hosp Infect. 2004 Mar;56(3):170–174. doi: 10.1016/j.jhin.2004.01.018. [DOI] [PubMed] [Google Scholar]