Abstract
BackgroundA six-fold increase in pediatric MRSA infections, prompted us to examine the clinical profile of children with MRSA infections seen at Mercy Children's Hospital, Toledo, Ohio and to characterize the responsible strains.MethodsRecords were reviewed of pediatric patients who cultured positive for MRSA from June 1 to December 31, 2007. Strain typing by pulsed field gel electrophoresis (PFT) and DiversiLab, SCCmec typing, and PCR-based lukSF-PV gene (encodes Panton-Valentine leukocidin), arginine catabolic mobile element (ACME) and cap5 gene detection was performed.ResultsChart review of 63 patients with MRSA infections revealed that 58(92%) were community acquired MRSA (CAMRSA). All CAMRSA were skin and soft tissue infections (SSTI). Twenty five (43%) patients were aged < 3 yrs, 19(33%) aged 4-12 and 14(24%) aged 13-18. Nineteen (76%) of those aged < 3 yrs had higher incidence of perineal infections compared to only 2(11%) of the 4-12 yrs and none of the 13-18 yrs of age. Infections in the extremities were more common in the older youth compared to the youngest children. Overall, there was a significant association between site of the infection and age group (Fisher's Exact p-value < 0.001). All CAMRSA were USA300 PFT, clindamycin susceptible, SCCmec type IVa and lukSF-PV gene positive. Nearly all contained ACME and about 80% were cap5 positive. Of the 58 USA300 strains by PFT, 55(95%) were also identified as USA300 via the automated repetitive sequence-based PCR method from DiversiLab.ConclusionsCAMRSA SSTI of the perineum was significantly more common among toddlers and that of the extremities in older children. The infecting strains were all USA300 PFT. Further studies are needed to identify the unique virulence and colonization characteristics of USA300 strains in these infections.
Highlights
A six-fold increase in pediatric Methicillin resistant S. aureus (MRSA) infections, prompted us to examine the clinical profile of children with MRSA infections seen at Mercy Children’s Hospital, Toledo, Ohio and to characterize the responsible strains
community acquired MRSA (CAMRSA) strains as defined by the Centers for Disease Control and Prevention (CDC) clinical criteria [4] have some general characteristics that differentiate them from healthcare associated MRSA (HAMRSA) strains, including the presence of the Staphylococcal chromosomal cassette - SCCmec type IVa that confers methicillin resistance, lukSF-PV genes that codes for Panton-Valentine leukocidin (PVL), arginine catabolic mobile element (ACME) element that contributes to skin colonization [5], antibiotic resistance patterns [3], and pulsed field types (PFT) [6]
From June 1, 2007 to December 31, 2007, 63 pediatric patients with MRSA infections were seen at the emergency room, outpatient clinics and the inpatient ward at Mercy Children’s Hospital
Summary
A six-fold increase in pediatric MRSA infections, prompted us to examine the clinical profile of children with MRSA infections seen at Mercy Children’s Hospital, Toledo, Ohio and to characterize the responsible strains. Methicillin resistant S. aureus (MRSA) remains one of the most prevalent pathogens isolated from hospital patients. MRSA infections are increasingly arising outside of healthcare settings among individuals in the community with no established risk factors. The incidence of invasive community acquired MRSA (CAMRSA) disease in previouslyhealthy children has been increasing [1,2,3]. A six-fold increase in the number of MRSA infections among children between 2002 and 2007 (p < 0.0001) (Figure 1) prompted us to examine both the clinical profile of the patients, and the molecular profile of the
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