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Community-acquired MRSA infections in North Carolina children: prevalence, antibiotic sensitivities, and risk factors.
N C Med J 2009 Mar-Apr; 70(2):102-7NC

Abstract

BACKGROUND

The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in children has increased dramatically over the past decade. CA-MRSA infections are often resistant to standard outpatient antibiotics and present a large burden to the health care system and to afflicted families.

OBJECTIVES

Our aims were to characterize the patterns of CA-MRSA resistance to common antibiotics and to identify significant risk factors for CA-MRSA infection in healthy children at a large urban hospital. Additional goals were to discover the prevalence of CA-MRSA in the institution and to observe any notable trends surrounding CA-MRSA infection in the facility.

METHODS

We retrospectively analyzed the medical records of patients under 18 years of age in the WakeMed Health and Hospitals system with cultures positive for Staphylococcus aureus over a period of seven and a half months in 2006. Cases were classified as community-acquired, and we then analyzed risk factors and examined trends surrounding CA-MRSA infection.

RESULTS

A total of 229 cases of Staphylococcus aureus infection were identified over the study period, of which 142 were CA-MRSA, a prevalence of 75.9% (95% CI, 69.5-82.3). Our CA-MRSA isolates were 98.6% sensitive to trimethoprim-sulfamethoxasole, 94.4% sensitive to tetracycline, 90.8% sensitive to clindamycin, and 59.9% sensitive to levofloxacin. Risk factors for CA-MRSA infection included parental employment in a school or daycare, family history of boils or MRSA, and antibiotic use by children in the past six months.

LIMITATIONS

Our definition of CA-MRSA is based on retrospective data from patient and family verbal histories in the medical record. We did not perform molecular genotyping of MRSA samples to confirm community-associated strains.

DISCUSSION

CA-MRSA is now the predominant strain of Staphylococcus aureus causing childhood infections in this central North Carolina hospital. Thus, standard antibiotic therapy with penicillins or first generation cephalosporins is no longer adequate for most pediatric skin and soft tissue infections in this population. Trimethoprim-sulfamethoxasole and clindamycin both appear as reasonable alternatives for empiric therapy.

Authors+Show Affiliations

Department of Pediatrics, University of North Carolina at Chapel Hill, USA. ashapiro@unch.unc.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19489364

Citation

Shapiro, Adam, et al. "Community-acquired MRSA Infections in North Carolina Children: Prevalence, Antibiotic Sensitivities, and Risk Factors." North Carolina Medical Journal, vol. 70, no. 2, 2009, pp. 102-7.
Shapiro A, Raman S, Johnson M, et al. Community-acquired MRSA infections in North Carolina children: prevalence, antibiotic sensitivities, and risk factors. N C Med J. 2009;70(2):102-7.
Shapiro, A., Raman, S., Johnson, M., & Piehl, M. (2009). Community-acquired MRSA infections in North Carolina children: prevalence, antibiotic sensitivities, and risk factors. North Carolina Medical Journal, 70(2), pp. 102-7.
Shapiro A, et al. Community-acquired MRSA Infections in North Carolina Children: Prevalence, Antibiotic Sensitivities, and Risk Factors. N C Med J. 2009;70(2):102-7. PubMed PMID: 19489364.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Community-acquired MRSA infections in North Carolina children: prevalence, antibiotic sensitivities, and risk factors. AU - Shapiro,Adam, AU - Raman,Sudha, AU - Johnson,Marilee, AU - Piehl,Mark, PY - 2009/6/4/entrez PY - 2009/6/6/pubmed PY - 2009/8/6/medline SP - 102 EP - 7 JF - North Carolina medical journal JO - N C Med J VL - 70 IS - 2 N2 - BACKGROUND: The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in children has increased dramatically over the past decade. CA-MRSA infections are often resistant to standard outpatient antibiotics and present a large burden to the health care system and to afflicted families. OBJECTIVES: Our aims were to characterize the patterns of CA-MRSA resistance to common antibiotics and to identify significant risk factors for CA-MRSA infection in healthy children at a large urban hospital. Additional goals were to discover the prevalence of CA-MRSA in the institution and to observe any notable trends surrounding CA-MRSA infection in the facility. METHODS: We retrospectively analyzed the medical records of patients under 18 years of age in the WakeMed Health and Hospitals system with cultures positive for Staphylococcus aureus over a period of seven and a half months in 2006. Cases were classified as community-acquired, and we then analyzed risk factors and examined trends surrounding CA-MRSA infection. RESULTS: A total of 229 cases of Staphylococcus aureus infection were identified over the study period, of which 142 were CA-MRSA, a prevalence of 75.9% (95% CI, 69.5-82.3). Our CA-MRSA isolates were 98.6% sensitive to trimethoprim-sulfamethoxasole, 94.4% sensitive to tetracycline, 90.8% sensitive to clindamycin, and 59.9% sensitive to levofloxacin. Risk factors for CA-MRSA infection included parental employment in a school or daycare, family history of boils or MRSA, and antibiotic use by children in the past six months. LIMITATIONS: Our definition of CA-MRSA is based on retrospective data from patient and family verbal histories in the medical record. We did not perform molecular genotyping of MRSA samples to confirm community-associated strains. DISCUSSION: CA-MRSA is now the predominant strain of Staphylococcus aureus causing childhood infections in this central North Carolina hospital. Thus, standard antibiotic therapy with penicillins or first generation cephalosporins is no longer adequate for most pediatric skin and soft tissue infections in this population. Trimethoprim-sulfamethoxasole and clindamycin both appear as reasonable alternatives for empiric therapy. SN - 0029-2559 UR - https://www.unboundmedicine.com/medline/citation/19489364/Community_acquired_MRSA_infections_in_North_Carolina_children:_prevalence_antibiotic_sensitivities_and_risk_factors_ L2 - https://medlineplus.gov/mrsa.html DB - PRIME DP - Unbound Medicine ER -