Skip to main content
×
Home
    • 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)...
Summary
SUMMARY

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.

Copyright
Corresponding author
*Author for correspondence: Dr C. R. Hermos, 55 Lake Avenue North, Worcester, MA, USA. (Email: Christina.hermos@umassmemorial.org)
References
Hide All
1.Rosenthal VD, et al. 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.Davis KA, et al. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clinical Infectious Diseases 2004; 39: 776782.
4.Milstone AM, et al. 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.
5.Calfee DP, et al. Strategies to prevent transmission of methicillin-resistant Staphylococcus aureus in acute care hospitals. Infection Control and Hospital Epidemiology 2008; 29 (Suppl. 1): S6280.
6.Siegel JD, et al. Management of multidrug-resistant organisms in healthcare settings. Atlanta, GA: Centers for Disease Control and Prevention, Department of Health and Human Services, USA, 2006.
7.King MD, et al. 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.Francis JS, et al. 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.Nakamura MM, et al. Prevalence of methicillin-resistant Staphylococcus aureus nasal carriage in the community pediatric population. Pediatric Infectious Disease Journal 2002; 21: 917922.
10.Hussain FM, Boyle-Vavra S, Daum RS. Community-acquired methicillin-resistant Staphylococcus aureus colonization in healthy children attending an outpatient pediatric clinic. Pediatric Infectious Disease Journal 2001; 20: 763767.
11.Cheng Immergluck L, et al. Prevalence of Streptococcus pneumoniae and Staphylococcus aureus nasopharyngeal colonization in healthy children in the United States. Epidemiology and Infection 2004; 132: 159166.
12.Fritz SA, et al. 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.Creech CB 2nd, et al. Increasing rates of nasal carriage of methicillin-resistant Staphylococcus aureus in healthy children. Pediatric Infectious Disease Journal 2005; 24: 617621.
14.Tenover FC, et al. 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.Otter JA, French GL. Nosocomial transmission of community-associated methicillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infectious Diseases 2006; 6: 753755.
16.Patel M, et al. USA300 genotype community-associated methicillin-resistant Staphylococcus aureus as a cause of surgical site infections. Journal of Clinical Microbiology 2007; 45: 34313433.
17.Seybold U, et al. 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.Maree CL, et al. Community-associated methicillin-resistant Staphylococcus aureus isolates causing healthcare-associated infections. Emerging Infectious Diseases 2007; 13: 236242.
19.Liu C, et al. 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.Klevens RM, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. Journal of the American Medical Association 2007; 298: 17631771.
21.McDougal LK, et al. 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.Koreen L, et al. 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.Harmsen D, et al. 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.
24.Shopsin B, et al. Evaluation of protein A gene polymorphic region DNA sequencing for typing of Staphylococcus aureus strains. Journal of Clinical Microbiology 1999; 37: 35563563.
25.Carey AJ, et al. Changes in the molecular epidemiological characteristics of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infection Control and Hospital Epidemiology 2010; 31: 613619.
26.Popovich K, et al. Phenotypic prediction rule for community-associated methicillin-resistant Staphylococcus aureus. Journal of Clinical Microbiology 2007; 45: 22932295.
27.David MD KA, et al. Community-associated methicillin-resistant Staphylococcusl aureus: nosocomial transmission in a neonatal unit. Journal of Hospital Infection 2006; 64: 244250.
28.Healy CM, et al. Emergence of new strains of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Clinical Infectious Diseases 2004; 39: 14601466.
29.McAdams RM, et al. Spread of methicillin-resistant Staphylococcus aureus USA300 in a neonatal intensive care unit. Pediatrics International 2008; 50: 810815.
30.Seybold U, et al. Emergence of and risk factors for methicillin-resistant Staphylococcus aureus of community origin in intensive care nurseries. Pediatrics 2008; 122: 10391046.
31.Flayhart D, et al. 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.
32.Clinical and Laboratory Standards Institute. Performance standards for antimicrobials susceptibility testing; seventeenth informational supplement M100-S17 2007; 27: 1182.
33.Oliveira DC, de Lencastre H. 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.McClure JA, et al. 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.
35.Nair N, et al. Molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) among patients admitted to adult intensive care units: The STAR*ICU Trial. Infection Control and Hospital Epidemiology 2011; 32: 10571063.
36.Milstone AM, et al. Community-associated methicillin-resistant Staphylococcus aureus strains in pediatric intensive care unit. Emerging Infectious Diseases 2010; 16: 647655.
37.Geva A, et al. Spread of methicillin-resistant Staphylococcus aureus in a large tertiary NICU: network analysis. Pediatrics 2011; 128: e11731180.
38.Gerber JS, et al. 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.Larsen AR, et al. 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.Huskins WC, et al. Intervention to reduce transmission of resistant bacteria in intensive care. New England Journal of Medicine 2011; 364: 14071418.
41.Jain R, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. New England Journal of Medicine 2011; 364: 14191430.
42.Gorwitz RJ. 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? *
×

Keywords:

Type Description Title
WORD
Supplementary Materials

Hermos Supplementary Material
Appendix

 Word (97 KB)
97 KB

Metrics

Full text views

Total number of HTML views: 5
Total number of PDF views: 15 *
Loading metrics...

Abstract views

Total abstract views: 154 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st October 2017. This data will be updated every 24 hours.