Methicillin-resistant Staphylococcus Aureus In Children Research Articles

Staphylococcus aureus infection in children: diagnosis and treatment in the context of antibiotic resistance spread

The emergence and rapid spread of methicillin-resistant Staphylococcus aureus (MRSA) isolates in the world significantly complicated the treatment and changed the approaches to the diagnosis of staphylococcal infections in children. Staphylococcus aureus is a widespread microorganism dangerous for humans. A wide range of virulence factors the list of which is still being added allows it to quickly enter the body through damaged barriers and cause local and invasive infections, toxin-mediated diseases, as well as persist for a long time. Currently, two fundamentally different variants of MRSA are distinguished: health care-associated and community-acquired. Health care-associated MRSA are resistant to a greater number of antimicrobial agents, while community-acquired MRSA isolates are characterized by recurrent infections and a more severe course of invasive diseases. In addition, MRSA is gradually developing resistance to those antibacterial agents that were the basis of treatment for these infections, primarily clindamycin and vancomycin. All this requires global and regional monitoring of MRSA spread in different variants of staphylococcal infections and the sensitivity of the isolates found to antibiotics in order to optimize empiric and pathogen-specific antibacterial therapy. The article presents data on the activity of various antimicrobial agents against S.aureus, analyzes the available information on the prevalence of MRSA in Ukraine and the results of local monitoring for antibiotic resistance, which turned out to be unidirectional with global trends. Clinical and laboratory criteria for diagnosis of local staphylococcal infections, invasive and toxin-mediated diseases in childhood were presented. Treatment of S.aureus infections involves the necessary surgical interventions and antibacterial therapy considering current epidemiological situation on the spread of MRSA and their sensitivity to antimicrobial agents. Further studies are needed to determine the prevalence of MRSA in children in Ukraine to develop antibacterial therapy algorithms for various types of staphylococcal infections.

Prevalence of methicillin-resistant Staphylococcus aureus in Iranian children: a systematic review and meta-analysis.

BackgroundAntibiotic resistance is associated with longer hospitalizations, higher treatment costs, and increased morbidity and mortality rates.PurposeThis study aimed to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Iranian children.MethodsInternational databases, including Web of Science, PubMed, Embase, and Scopus, and Iranian databases, including Scientific Information Database (www.sid.ir), Magiran, and Iranian Database for Medical Literature (idml.research.ac.ir), were systematically searched for articles published between January 2000 and August 2019. Sources of heterogeneity were determined using subgroup analysis and meta-regression.ResultsOverall, 343 studies were identified; of them, 20 were included in the meta-analysis to estimate the pooled prevalence. The pooled prevalence of MRSA was 42% (95% confidence interval [CI], 29–55) among culture-positive cases of S. aureus, 51% (95% CI, 39–62) in hospitalized children, and 14% (95% CI, 0.05–27) in healthy children.ConclusionThe overall pooled prevalence of MRSA in children was 42%. Appropriate infection control measures and effective antibiotic therapy are needed.

Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in Children: a Reappraisal of Vancomycin.

In the last 50years, vancomycin has been the agent of choice to treat infections due to methicillin-resistant Staphylococcus aureus (MRSA). However, vancomycin treatment failure is not uncommon, even when MRSA strains are fully susceptible to vancomycin. Treatment with vancomycin requires careful monitoring of drug levels as there is a potential for nephrotoxicity. Resistance to clindamycin is not infrequent, which also limits therapeutic options for treating infections due to MRSA in children. This paper reviews the current data on pharmacokinetics and pharmacodynamics and clinical efficacy of vancomycin in children. Resistance to vancomycin in MRSA (MIC >2mg/L) is infrequent; there is increasing evidence in the literature that vancomycin maybe ineffective against increasing proportion of isolates with MICs between 1 and 2mg/L. Recent studies and meta-analyses have demonstrated that strains with high vancomycin MICs are associated with poor outcomes especially in patients with bacteremia and deep tissue infections due to MRSA. This gradual increase in vancomycin MIC has been reported as MIC creep or vancomycin heteroresistance. Patients infected with MRSA isolates that exhibit MIC creep experience poorer clinical outcomes, including delayed treatment response, increased mortality, increase rate of relapse, and extended hospitalization. There are limited data to guide vancomycin dosing in children with MRSA. Although the vancomycin area under the curve AUC24/MIC ratio > 400 has been shown to predict clinical efficacy in adults, this relationship has not been documented very well for treatment outcomes in MRSA infections in children. Use of higher vancomycin dosages in attempts to achieve higher trough concentrations has been associated with increased nephrotoxicity. New recently approved antibiotics including ceftaroline, dalbavancin, and tedizolid offer a number of advantages over vancomycin to treat staphylococcal infections: improved antimicrobial activity, superior pharmacokinetics, pharmacodynamics, tolerability, and dosing, including once-daily and weekly regimens, and less need for monitoring drug levels.

Fingernail Carriage of Methicillin-Resistant Staphylococcus aureus and Possible Correlation with Soft Tissue Infections in Children.

Community-associated methicillin-resistant Staphylococcus aureus (MRSA) is a growing problem in the pediatric population, causing many soft tissue infections. This study was designed to examine fingernail carriage of MRSA in children and their caregivers as a possible link to community-associated MRSA soft tissue infections in children. We documented the prevalence of MRSA under the fingernails of children and the caregivers of pediatric patients with soft tissue infections and compared the prevalence with MRSA under the fingernails of children and the caregivers of children with no history of soft tissue infections. Children with soft tissue infections and their caregivers (50 subjects) had three fingernails of each hand swabbed and plated and these were compared with a control group of children and their caregivers (150 subjects) who had no history of MRSA or soft tissue infection. Caregivers and children in the study group were more likely than caregivers and the children in the control group to have MRSA under their fingernails (P < 0.05). Soft tissue infections in the study group were found most commonly in the diapering area (66%). MRSA carriage was evident under the fingernails of children and caregivers. Caregivers and their children who have soft tissue infections are more likely to have MRSA growth under fingernails than caregivers or their children who have no history of MRSA or soft tissue infections. Our study suggests that caregivers could be contributing to soft tissue infections in their children.

Prospective, cross-sectional study on MSSA and MRSA colonisation in hospitalised children.

The prevalence of MRSA in children admitted to the UKBB during this surveillance period was zero. General MRSA screening in hospitalised children continues to be unjustified in our area. • The prevalence of nasal methicillin-resistant Staphylococcus aureus (MRSA) colonisation in children is increasing in many regions worldwide. • Surveillance for MRSA colonisation in healthcare settings varies considerably. • Periodic and risk-factor-based surveillance for MRSA colonisation is sufficient when regional prevalence is low.

Methicillin-resistant Staphylococcus aureus in children with atopic dermatitis from 1999 to 2014: A longitudinal study.

With the increase in rates of methicillin-resistant Staphylococcus aureus (MRSA) skin infections in the general population, there may be a similar increase of such infections in patients with atopic dermatitis (AD). There are few studies on MRSA prevalence in the AD population, and no previous studies in Australia. This study investigated the prevalence of MRSA and other organisms in the paediatric AD population over the previous 15 years. Skin swab results and other significant data, including patients' characteristics and comorbidities, were collected on patients with AD aged 0-18 years, admitted to a large teaching hospital in South Australia from 1999 to 2014 (N = 298). This longitudinal, retrospective study investigated, using logistic regression, the change of prevalence of MRSA, methicillin-sensitive S. aureus (MSSA) and Streptococcus spp. in AD over the past 15 years. Compared with 1999-2002, in 2003-2006 patients were approximately threefold more likely (P = 0.350), in 2007-2010 they were approximately 13-fold more likely (P = 0.030) and in 2011-2014 they were approximately 24-fold more likely to test positive for MRSA (P = 0.008), despite low absolute MRSA numbers. There was a positive association between the number of previous hospital admissions per patient and MRSA (OR = 1.16 [1.08-1.25], P = 0.000). In contrast, there was no change in the prevalence of MSSA or Streptococcus spp. over time. The prevalence of MRSA in children with AD is clearly on the rise. This has negative consequences for individuals with AD and is also a major public health problem.

Community-Associated Methicillin-ResistantStaphylococcus aureusin a Pediatric Emergency Department in Newfoundland and Labrador

First-generation cephalosporins and antistaphylococcal penicillins are typically the first choice for treating skin and soft tissue infections (SSTI), but are not effective for infections caused by methicillin-resistant Staphylococcus aureus (MRSA). It is currently unclear what percentage of SSTIs is caused by community-associated MRSA in different regions in Canada. To determine the incidence of MRSA in children presenting to a pediatric emergency department with SSTI, and to determine which antibiotics were used to treat these infections. All visits to a pediatric emergency department were reviewed from April 15, 2010 to April 14, 2011. Diagnoses of cellulitis, abscess, impetigo, folliculitis and skin infection (not otherwise specified) were reviewed in detail to determine whether a culture was taken and which antibiotic was prescribed. There were 367 cases of SSTI diagnosed over the study period. Forty-five (12.3%) patients had lesions that were swabbed for culture and sensitivity. S aureus was the most common organism found, with 14 (66%) methicillin-sensitive cases and seven (33%) methicillin-resistant cases. Of the seven cases of MRSA identified, only one patient had clear risk factors for hospital-acquired MRSA. First-generation cephalosporins were initially prescribed for 280 (76%) patients. The overall incidence of MRSA in the population presenting to a pediatric emergency department in Newfoundland and Labrador appeared to be low, although only a small percentage of infections were cultured. At this time, there appears to be no need to change empirical antibiotic coverage, which remains a first-generation cephalosporin.

MRSA in children from foreign countries adopted to Swedish families

To determine if children adopted to Swedish families from countries with a high carrier rate of methicillin-resistant Staphylococcus aureus (MRSA) are infected or colonized with MRSA. From January 2000 to May 2005, 23 adopted children from 6 countries were examined for MRSA at the University hospital in Lund after their arrival in Sweden. Thirteen of the 23 children (57%) were MRSA positive with a median age of the children at the time MRSA was detected of 6 (range 3-16) months. All MRSA positive children had a history of hospitalization in their native country before arriving in Sweden. The throat was the most frequent and persistent site where MRSA was seen while in sites such as the anterior nares and perineum, MRSA was found more intermittently. The MRSA-positive children were adopted into 13 Swedish families and in 3 families, 6 of 10 family members became MRSA positive. Children adopted from foreign countries to Swedish families and with a history of hospitalization in their native country were commonly colonized with MRSA. The throat was the most frequent site colonized and transmission of MRSA from adopted children to other family members occurred.

Research Foundation Award for the Best International Abstract, Blue Ribbon Abstract Award: The nasal carriage of methicillin-resistant Staphylococcus aureus in children with allergy

BACKGROUND: Staphylococcus aureus (SA) enterotoxins have been suggested to have an impact on specific local IgE production in nasal polyps in patients with allergy. Hypothetically high level of the local IgE during long period maybe associated with methicillin-resistant Staphylococcus aureus (MRSA) formation in the upper respiratory tract in this enlarging group of children with allergy. The aim of the present investigation was to detect the amount of MRSA carriers among children with allergy: nasal polyposis (NP) and allergic rhinitis (AR). METHODS: Nasopharyngeal swabs for SA and MRSA and nasal tissue samples were taken from 1020 children (ages 2-3, 4-7, 8-12) with NP (456 persons) and AR (564 persons) and 980 healthy children (ages 2-12) enrolled for long-term study from 1999 through 2004. Patient's age, gender, diagnosis of allergy, therapy, IgE levels, and use of antibiotics was recorded. Antibiotic resistance of the strains was determined with the disc diffusion method. Nasal tissue samples were analyzed for total and specific IgE to SA. Nonlineal diagnosis system (NLS) method was used to support analysis and demonstration. RESULTS: The rates of nasal carriage of SA were found to be 15% (147/980) in the control group and 62% (632/1020) in patients with NP and AR. MRSA was found in 2% of control and in 29% of patients with NP and AR in 1999, 3% and 32% in 2000, 2% and 37% in 2001, 1% and 40% in 2002, 1% and 52% in 2003, and 1% and 66% patients in 2004. B1 MRSA strain was predominant. Children ages 4-7 years (p = 0.02), glucocorticoid use in NP (p = 0.02), rate of hospitalization (p = 0.005), and specific local IgE level (p = 0.001) were significantly associated with MRSA colonization. Results were confirmed by NLS in 79% of samples. CONCLUSION: The nasal carriage of MRSA in patients with nasal polyposis is high, undetectable, and growing. It is possible that allergy maybe the cause of nasal carriage of MRSA. Children with NP and AR are an unidentified and less well studied group at high risk for spreading MRSA in children's hospitals, day-care centers, and schools. NLS opens up possibilities for screening for MRSA carriers.

Clindamycin treatment of methicillin-resistant Staphylococcus aureus infections in children.

Methicillin-resistant Staphylococcus aureus (MRSA) with a narrower antibiotic resistance pattern have emerged. There is a risk for the appearance of resistance during clindamycin therapy of erythromycin-resistant MRSA infections because of the linked resistance mechanisms. We analyzed clindamycin-susceptible MRSA organisms from children (1987 to 2000) along with clinical data. Antibiotic susceptibilities of organisms were tested, pulsed field gel electrophoresis (PFGE) was done and the linked resistance mechanism was detected by the D test. An average of 11 clindamycin-susceptible MRSA per year were obtained from children since 1993. Of 88 isolates 33 (38%) were erythromycin-resistant. The latter were less often community-acquired (45% vs. 69%), more often from infants <1 month of age (24% vs. 4%) and less likely to be in the community acquisition-associated PFGE Group 1 (62% vs. 87%) than those that were susceptible. The D test was positive in 31 of 33 erythromycin-resistant isolates. A 9-month-old boy with pneumonia/empyema caused by a clindamycin-susceptible, erythromycin-resistant, D test-positive MRSA developed a PFGE-identical clindamycin-resistant isolate and clinical relapse during clindamycin treatment. In contrast a 12-year-old girl with abscesses caused by a similar MRSA developed another abscess after clindamycin therapy, but the organism was unchanged in susceptibility. Erythromycin resistance was present in 38% of clindamycin-susceptible MRSA in children, and clindamycin resistance was detected during treatment in one child. Clindamycin remains a treatment option if the clinician is notified of the risk by the microbiology laboratory and the clinical situation is suitable.

Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk.

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections in children have occurred primarily in individuals with recognized predisposing risks. Community-acquired MRSA infections in the absence of identified risk factors have been reported infrequently. To determine whether community-acquired MRSA infections in children with no identified predisposing risks are increasing and to define the spectrum of disease associated with MRSA isolation. Retrospective review of medical records. Hospitalized children with S aureus isolated between August 1988 and July 1990 (1988-1990) and between August 1993 and July 1995 (1993-1995). The University of Chicago Children's Hospital. Prevalence of community-acquired MRSA over time, infecting vs colonizing isolates, and risk factors for disease. The number of children hospitalized with community-acquired MRSA disease increased from 8 in 1988-1990 to 35 in 1993-1995. Moreover, the prevalence of community-acquired MRSA without identified risk increased from 10 per 100000 admissions in 1988-1990 to 259 per 100000 admissions in 1993-1995 (P<.001), and a greater proportion of isolates produced clinical infection. The clinical syndromes associated with MRSA in children without identified risk were similar to those associated with community-acquired methicillin-susceptible S aureus. Notably, 7 (70%) of 10 community-acquired MRSA isolates obtained from children with an identified risk were nonsusceptible to at least 2 drugs, compared with only 6 (24%) of 25 isolates obtained from children without an identified risk (P=.02). These findings demonstrate that the prevalence of community-acquired MRSA among children without identified risk factors is increasing.