Risk of Skin and Soft Tissue Infections among Children Found to be Staphylococcus aureus MRSA USA300 Carriers

Lilly Immergluck,Anaam Mohammed,Robert Mayberry,Trisha Parker,Sarah Satola,Susan Ray,Shabnam Jain,Robert Jerris,Keming Yuan

doi:10.5811/westjem.2016.10.30483

Lilly Immergluck, Anaam Mohammed + Show 7 more

Open Access

https://doi.org/10.5811/westjem.2016.10.30483

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Abstract

IntroductionThe purpose of this study was to examine community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) carriage and infections and determine risk factors associated specifically with MRSA USA300.MethodsWe conducted a case control study in a pediatric emergency department. Nasal and axillary swabs were collected, and participants were interviewed for risk factors. The primary outcome was the proportion of S. aureus carriers among those presenting with and without a skin and soft tissue infection (SSTI). We further categorized S. aureus carriers into MRSA USA300 carriers or non-MRSA USA300 carriers.ResultsWe found the MRSA USA300 carriage rate was higher in children less than two years of age, those with an SSTI, children with recent antibiotic use, and those with a family history of SSTI. MRSA USA300 carriers were also more likely to have lower income compared to non-MRSA USA300 carriers and no S. aureus carriers. Rates of Panton-Valentine leukocidin (PVL) genes were higher in MRSA carriage isolates with an SSTI, compared to MRSA carriage isolates of patients without an SSTI. There was an association between MRSA USA300 carriage and presence of PVL in those diagnosed with an abscess.ConclusionChildren younger than two years were at highest risk for MRSA USA300 carriage. Lower income, recent antibiotic use, and previous or family history of SSTI were risk factors for MRSA USA300 carriage. There is a high association between MRSA USA300 nasal/axillary carriage and presence of PVL in those with abscesses.

Highlights

The purpose of this study was to examine community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) carriage and infections and determine risk factors associated with MRSA USA300
There was an association between MRSA USA300 carriage and presence of Panton-Valentine leukocidin (PVL) in those diagnosed with an abscess
There is a high association between MRSA USA300 nasal/axillary carriage and presence of PVL in those with abscesses. [West J Emerg Med. 2017;18(2)201-212.]

Summary

Introduction

The purpose of this study was to examine community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) carriage and infections and determine risk factors associated with MRSA USA300. Infections of Staphylococcus aureus MRSA USA300 Carriers infection in hospitalized populations.[10,11,12,13,14,15] Reports addressing pediatric carriage in community settings[16,17,18, 19,20] have primarily focused on carriage in the context of transmission to household contacts[21] or known risk factors, e.g., daycare attendance[22] or outbreak settings, e.g., newborn nurseries.[23] There are fewer studies addressing S. aureus carriage among healthy children[24,25] and its association with SSTIs in these otherwise-healthy children.[6,26] Fritz et al demonstrated that 76% of children found to have MRSA SSTI were colonized with MRSA.[27] Atopic conditions, e.g., eczema, asthma, have been associated with the development of SSTIs.[28] Atopic dermatitis is a chronic condition complicated by high rates of S. aureus infections, and children with this condition are known to frequently be carriers of S. aureus[29]

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