Skip to main content
    • Aa
    • Aa

Changing epidemiology of methicillin-resistant Staphylococcus aureus colonization in paediatric intensive-care units

  • C. R. HERMOS (a1), T. J. SANDORA (a2) (a3), L. E. WILLIAMS (a2), N. MOSAMMAPARAST (a4) and A. J. McADAM (a2)...

Community-associated methicillin-resistant S. aureus (CA-MRSA) accounts for a growing proportion of hospital-onset infections, and colonization is a risk factor. This study aimed to determine changes in the prevalence of CA-MRSA colonization in paediatric intensive-care units (ICUs). A total of 495 paediatric patients colonized with MRSA from neonatal, medical, surgical, and cardiac ICUs between 2001 and 2009 were identified. Isolates were characterized by spa type, staphylococcal cassette chromosome (SCC) mec type and the presence of the genes encoding Panton–Valentine leukocidin (PVL). The proportion of patients colonized with MRSA remained stable (average 3·2%). The proportion of isolates with spa type 1, SCCmec type IV and PVL increased over time to maximums in 2009 of 36·1% (P < 0·001), 54·2% (P = 0·03) and 28·9% (P = 0·003), respectively. Antibiotic susceptibility patterns showed increasing proportions susceptible to clindamycin, gentamicin, tetracycline and trimethoprim-sulfamethoxazole (P values <0·001). In conclusion, the proportion of MRSA-colonized children in ICUs with CA-MRSA increased significantly over time.

Corresponding author
*Author for correspondence: Dr C. R. Hermos, 55 Lake Avenue North, Worcester, MA, USA. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. VD Rosenthal , International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003–2008, issued June 2009. American Journal of Infection Control 2010; 38: 95104 e102.

2.National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. American Journal of Infection Control 2004; 32: 470485.

3. KA Davis , Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clinical Infectious Diseases 2004; 39: 776782.

4. AM Milstone , Methicillin-resistant Staphylococcus aureus colonization and risk of subsequent infection in critically ill children: importance of preventing nosocomial methicillin-resistant Staphylococcus aureus transmission. Clinical Infectious Diseases 2011; 53: 853859.

7. MD King , Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Annals of Internal Medicine 2006; 144: 309317.

8. JS Francis , Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes. Clinical Infectious Diseases 2005; 40: 100107.

9. MM Nakamura , Prevalence of methicillin-resistant Staphylococcus aureus nasal carriage in the community pediatric population. Pediatric Infectious Disease Journal 2002; 21: 917922.

12. SA Fritz , Prevalence of and risk factors for community-acquired methicillin-resistant and methicillin-sensitive Staphylococcus aureus colonization in children seen in a practice-based research network. Pediatrics 2008; 121: 10901098.

13. CB Creech 2nd, Increasing rates of nasal carriage of methicillin-resistant Staphylococcus aureus in healthy children. Pediatric Infectious Disease Journal 2005; 24: 617621.

14. FC Tenover , Characterization of a strain of community-associated methicillin-resistant Staphylococcus aureus widely disseminated in the United States. Journal of Clinical Microbiology 2006; 44: 108118.

15. JA Otter , GL French . Nosocomial transmission of community-associated methicillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infectious Diseases 2006; 6: 753755.

16. M Patel , USA300 genotype community-associated methicillin-resistant Staphylococcus aureus as a cause of surgical site infections. Journal of Clinical Microbiology 2007; 45: 34313433.

17. U Seybold , Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clinical Infectious Diseases 2006; 42: 647656.

18. CL Maree , Community-associated methicillin-resistant Staphylococcus aureus isolates causing healthcare-associated infections. Emerging Infectious Diseases 2007; 13: 236242.

19. C Liu , A population-based study of the incidence and molecular epidemiology of methicillin-resistant Staphylococcus aureus disease in San Francisco, 2004–2005. Clinical Infectious Diseases 2008; 46: 16371646.

20. RM Klevens , Invasive methicillin-resistant Staphylococcus aureus infections in the United States. Journal of the American Medical Association 2007; 298: 17631771.

21. LK McDougal , Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. Journal of Clinical Microbiology 2003; 41: 51135120.

22. L Koreen , spa typing method for discriminating among Staphylococcus aureus isolates: implications for use of a single marker to detect genetic micro- and macrovariation. Journal of Clinical Microbiology 2004; 42: 792799.

23. D Harmsen , Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. Journal of Clinical Microbiology 2003; 41: 54425448.

26. K Popovich , Phenotypic prediction rule for community-associated methicillin-resistant Staphylococcus aureus. Journal of Clinical Microbiology 2007; 45: 22932295.

27. MD KA David , Community-associated methicillin-resistant Staphylococcusl aureus: nosocomial transmission in a neonatal unit. Journal of Hospital Infection 2006; 64: 244250.

28. CM Healy , Emergence of new strains of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Clinical Infectious Diseases 2004; 39: 14601466.

29. RM McAdams , Spread of methicillin-resistant Staphylococcus aureus USA300 in a neonatal intensive care unit. Pediatrics International 2008; 50: 810815.

30. U Seybold , Emergence of and risk factors for methicillin-resistant Staphylococcus aureus of community origin in intensive care nurseries. Pediatrics 2008; 122: 10391046.

31. D Flayhart , Multicenter evaluation of BBL CHROMagar MRSA medium for direct detection of methicillin-resistant Staphylococcus aureus from surveillance cultures of the anterior nares. Journal of Clinical Microbiology 2005; 43: 55365540.

33. DC Oliveira , H de Lencastre . Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus. Antimicrobial Agents and Chemotherapy 2002; 46: 21552161.

34. JA McClure , Novel multiplex PCR assay for detection of the staphylococcal virulence marker Panton-Valentine leukocidin genes and simultaneous discrimination of methicillin-susceptible from -resistant staphylococci. Journal of Clinical Microbiology 2006; 44: 11411144.

36. AM Milstone , Community-associated methicillin-resistant Staphylococcus aureus strains in pediatric intensive care unit. Emerging Infectious Diseases 2010; 16: 647655.

37. A Geva , Spread of methicillin-resistant Staphylococcus aureus in a large tertiary NICU: network analysis. Pediatrics 2011; 128: e11731180.

38. JS Gerber , Trends in the incidence of methicillin-resistant Staphylococcus aureus infection in children's hospitals in the United States. Clinical Infectious Diseases 2009; 49: 6571.

39. AR Larsen , Two distinct clones of methicillin-resistant Staphylococcus aureus (MRSA) with the same USA300 pulsed-field gel electrophoresis profile: a potential pitfall for identification of USA300 community-associated MRSA. Journal of Clinical Microbiology 2009; 47: 37653768.

40. WC Huskins , Intervention to reduce transmission of resistant bacteria in intensive care. New England Journal of Medicine 2011; 364: 14071418.

41. R Jain , Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. New England Journal of Medicine 2011; 364: 14191430.

42. RJ Gorwitz . Understanding the success of methicillin-resistant Staphylococcus aureus strains causing epidemic disease in the community. Journal of Infectious Diseases 2008;197: 179182.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary Materials

Hermos Supplementary Material

 Word (97 KB)
97 KB


Full text views

Total number of HTML views: 5
Total number of PDF views: 8 *
Loading metrics...

Abstract views

Total abstract views: 110 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 29th May 2017. This data will be updated every 24 hours.