Methicillin resistant Staphylococcus aureus infections in children: A prospective study

Abstract

Community acquired MRSA (CA MRSA) can cause invasive diseases posing a challenge to treating physicians. The knowledge about the disease load, clinical pattern, risk factors, outcome and susceptibility pattern in a given geo demographic context contribute crucially to the treatment outcome of MRSA infections in children. To study the profile, clinical pattern, factors affecting the immediate outcome and antimicrobial susceptibility of MRSA infections in children A prospective observational study was conducted in children between 2 months and 12 years admitted with MRSA infections, from January 2016 to December 2017 in the Institute of Maternal and Child Health, Government Medical College Kozhikode, Kerala state, India. Out of 431 children evaluated 83(19.3%) had MRSA infections with 44(53%) CA MRSA and 39(47%) hospital associated MRSA (HA MRSA). Twenty one (53.8%) of HA MRSA infections were hospital onset MRSA (HAHO MRSA) and 18(46.2%) community onset MRSA (HACO MRSA). There were 37 infants, 16 toddlers, 12 preschool children, 18 school children, 48 males and 35 females in the study population. Blood (50.6%), pus (33.7%), and body fluids (15.7%) were the sites of isolation. Skin and soft tissue infections (SSTI)(30.10%), pneumonia (28.90%), empyema (9.64%), meningitis (7.23%), septicaemia (12.05%), bone and joint infections (9.64%), peritonitis (2.41%) and septic shock (18.1%) were the clinical presentation. Mortality occurred in 9.9% and paediatric intensive care requirement in 45.8% patients. Anaemia and thrombocytopenia were identified as the risk factors for PICU admissions (corrected OR; 95% C I, 3.38; 1.02–11.18 and 8.35; 1.35–45.03 respectively). Thrombocytopenia was associated with mortality (corrected OR 43.74, 95% C I 3.86–495.9). Susceptibility to clindamycin, co-trimoxazole, amikacin and rifampicin were 79.5%, 73.5%, 68.7% and 90.4% respectively. MRSA constituted a significant proportion of bacterial infections in children, the majority being community onset. Pneumonia and empyema predominate over SSTI. Thrombocytopenia was associated with mortality and PICU admission. Clindamycin, co-trimoxazole and amikacin can be utilised in the treatment of less severe MRSA infections