1126 METHICILLIN RESISTANT S. AUREUS INFECTIONS IN PEDIATRICS

Abstract

Methicillin resistant S. aureus (MRSA) is endemic on adult services in our hospital; however, prior to 1983 MRSA was rarely recovered from pediatric patients. In the 1 year period from October 1983 through September 1984, 13 MRSA isolates were recovered from 12 pediatric inpatients. There were 12 episodes of infection. One isolate was of indeterminate significance. Eleven infections were nosocomial and one was apparently community acquired. Ten of the nosocomial infections were related to surgery. There were 6 wound infections, 2 CSF shunt infections, 1 intra-abdominal abscess, and 1 infected Broviac catheter. Two patients had MRSA bacteremia and one had hematogenously disseminated staphylococcal disease although blood cultures were negative. Five distinct phage types of MRSA were identified. There was one isolate each of phage type 77, 84; 83A, 85, 81; and 29, 52, 52A, 79, 80, 6, 47, 53, 54, 83A, 85, 81. Two of 10 isolates were not susceptible to international or NYC experimental phages. Eight of 10 isolates, not typable by international phages were lysed by NYC experimental phage 88 and were from patients cared for on a single pediatric ward housing both medical and surgical patients. CDC isolation precautions were instituted for each patient in whom MRSA was identified. There was no evidence of spread between medical and surgical patients suggesting that this endemic hospital strain was sporadically imported from surgical services. A point prevalence survey on all patients on that ward failed to identify any other colonized pediatric patients. The absence of intra-ward spread suports the efficacy of CDC precautions in preventing patient to patient transmission of MRSA.