Monday, May 29, 2023
| Characteristic | Patients Screened for MRSA, n = 1,210 | Patients Not Screened for MRSA, n = 464 | p Value |
| Demographic | |||
| Median age, y (IQR) | 5 (0–12) | 6 (1–12) | 0.28 |
| Male sex | 667 (55) | 255 (56) | 0.78 |
| Race | |||
| White | 676 (56) | 234 (51) | Referent† |
| African American | 403 (33) | 173 (37) | 0.07 |
| Other | 131 (11) | 57 (12) | 0.19 |
| Clinical | |||
| Known MRSA carrier‡ | 41 (3) | 12 (3) | 0.40 |
| Hospitalized in previous 12 mo | 355 (29) | 102 (22) | < 0.01 |
Characteristics of Patients Screened for and not Screened for MRSA Colonization at the Time of PICU Admission, the Johns Hopkins University Hospital, Baltimore, MD, USA, March 2007–May 2008
*MRSA, methicillin-resistant Staphylococcus aureus; PICU, pediatric intensive care unit; IQR, interquartile range. Values reported as no. (%) unless otherwise specified.
†Obtained from univariate logistic regression analysis.
‡Patients with institutional history of MRSA colonization or infection.
| Characteristic | Group 1,† n = 72 | Group 2,‡ n = 1,117 | Group 3, n = 24§ | p Value | |||
|---|---|---|---|---|---|---|---|
| Group 2 vs. Group 1 | Group 3 vs. Group 1 | ||||||
| Demographic | |||||||
| Median age, y (IQR) | 3 (0–7.5) | 5 (1–12) | 10.5 (3–13) | 0.02 | < 0.01 | ||
| Male sex | 38 (53) | 616 (55) | 13 (54) | 0.69 | 0.91 | ||
| Race | |||||||
| White | 28 (39) | 640 (57) | 10 (42) | Referent¶ | Referent¶ | ||
| African American | 39 (54) | 352 (32) | 13 (54) | < 0.001 | 0.89 | ||
| Other | 5 (7) | 126 (11) | 1 (4) | 0.86 | 0.62 | ||
| Clinical | |||||||
| Known MRSA carrier# | 18 (25) | 0 (0) | 24 (100) | ||||
| Hospitalization in previous 12 mo | 42 (58) | 308 (28) | 14 (58) | < 0.001 | 0.41 | ||
| Outcomes | |||||||
| PICU length of stay,** median (IQR) | 3 (1–7) | 2 (1–4) | 2.5 (1–9) | < 0.001 | 0.96 | ||
| Hospital length of stay,** median (IQR) | 8 (3.5–15.5) | 5 (3–10) | 6 (3/5–14.5) | < 0.01 | 0.70 | ||
Characteristics of Patients With and Without MRSA Colonization at the Time of PICU Admission, the Johns Hopkins University Hospital, Baltimore, MD, USA, March 2007–May 2008*
*MRSA, methicillin-resistant Staphylococcus aureus; PICU, pediatric intensive care unit; IQR, interquartile range. Values reported as no. (%) unless otherwise
specified.
†MRSA colonized: patients who had MRSA grow in an admission nasal surveillance culture or in any clinical culture within 3 days of PICU admission.
‡Not MRSA colonized/no institutional history of MRSA colonization.
§Not MRSA colonized/institutional history of MRSA colonization.
¶Obtained from univariate logistic regression analysis.
#Patients with institutional history of MRSA colonization or infection.
**Data were log transformed before regression analysis to account for skewing.
| Characteristic | Patients Colonized With CA-MRSA Strain, n = 40 | Patients Colonized With HA-MRSA Strain, n = 26 | OR (95% CI)† |
|---|---|---|---|
| Demographic | |||
| Median age, y (IQR) | 3.8 (1.0–5.9) | 4.0 (1.0–9.5) | 0.98 (0.90–1.07) |
| Male sex | 22 (55) | 14 (54) | 1.05 (0.39–2.82) |
| Race | |||
| White | 15 (35) | 9 (38) | Referent |
| African American | 23 (58) | 13 (50) | 1.1 (0.36–3.10) |
| Other | 2 (5) | 4 (15) | 0.3 (0.05–1.98) |
| Clinical | |||
| Newly identified MRSA carrier | 32 (80) | 20 (77) | 1.2 (0.36–3.97) |
| Hospitalized in previous 12 mo | 20 (50) | 19 (73) | 0.37 (0.13–1.07) |
| ICU admission in previous 12 mo | 13 (33) | 26 (62) | 0.31 (0.11–0.84) |
| Length of stay in hospital before | 0 (0–28) | 0 (0–14) | 1.02 (0.92–1.15) |
| PICU admission, median (range) | |||
| Primary service | |||
| Medical | 24 (60) | 12 (46) | Referent |
| Surgical | 16 (40) | 14 (54) | 0.57 (0.21–1.55) |
| Admitted to PICU from inpatient unit | 6 (19) | 5 (15) | 0.74 (0.20–2.73) |
| Outcomes | |||
| PICU length of stay,‡ median (IQR) | 3 (1–7.5) | 3 (2–7) | 1.05 (0.79–1.40) |
| Hospital length of stay,‡ median (IQR) | 8 (4.5–28.5) | 8.5 (3–15) | 1.04 (0.97–2.04) |
Characteristics of Patients Colonized With Different MRSA Strain Types at the Time of PICU Admission, the Johns Hopkins Hospital, Baltimore, MD, USA, March 2007–May 2008*
*MRSA, methicillin-resistant Staphylococcus aureus; PICU, pediatric intensive care unit; CA-MRSA, community-associated MRSA;
HA-MRSA, hospitalassociated MRSA; OR, odds ratio; CI, confidence interval; IQR, interquartile range. Values reported as no.
(%) unless otherwise specified.
†Obtained from univariate logistic regression analysis.
‡Data were log transformed before regression analysis to account for skewing.
| Patient no. | Age, y | Culture Type | Days In PICU Before MRSA Acquisition | Strain Type | Clinical Service |
|---|---|---|---|---|---|
| 1 | 7.0 | Clin | 19 | A | Surg |
| 2 | 4.5 | Surv | 7 | A | Med |
| 3 | 11.2 | Surv | 5 | B | Surg |
| 4 | 2.5 | Surv | 9 | USA300 | Surg |
| 5 | 1.2 | Surv | 5 | USA300 | Surg |
| 6 | 9.9 | Surv | 24 | USA300 | Surg |
| 7 | 3.8 | Clin | 5 | USA300 | Surg |
| 8 | 7.5 | Surv | 5 | Unknown | Med |
Characteristics of Patients Who Acquired MRSA Colonization in the PICU, the Johns Hopkins University Hospital, Baltimore, MD, USA, March 2007–2008*
*MRSA, methicillin-resistant Staphylococcus aureus; PICU, pediatric intensive care unit; Clin, clinical; Surg, surgical; Surv, surveillance; Med, medical.
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Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine
This activity is intended for primary care physicians, infectious disease specialists, pediatricians, pediatric intensive care specialists, and other physicians who care for children.
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Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine
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Virulent community-associated methicillin-resistant Staphylococcus-aureus (CA-MRSA) strains have spread rapidly in the United States. To characterize the degree to which CA-MRSA strains are imported into and transmitted in pediatric intensive care units (PICU), we performed a retrospective study of children admitted to The Johns Hopkins Hospital PICU, March 1, 2007–May 31, 2008. We found that 72 (6%) of 1,674 PICU patients were colonized with MRSA. MRSA-colonized patients were more likely to be younger (median age 3 years vs. 5 years; p = 0.02) and African American (p< 0.001) and to have been hospitalized within 12 months (p< 0.001) than were noncolonized patients. MRSA isolates from 66 (92%) colonized patients were fingerprinted; 40 (61%) were genotypically CA-MRSA strains. CA-MRSA strains were isolated from 50% of patients who became colonized with MRSA and caused the only hospital-acquired MRSA catheter-associated bloodstream infection in the cohort. Epidemic CA-MRSA strains are becoming endemic to PICUs, can be transmitted to hospitalized children, and can cause invasive hospital-acquired infections. Further appraisal of MRSA control is needed.
Methicillin-resistant Staphylococcus aureus (MRSA) frequently infects children. Traditionally, MRSA infections were confined to those who frequented healthcare facilities or had predisposing healthcare-associated risk factors. In the 1990s, reports emerged of MRSA infections in healthy children in the community who had no predisposing risk factors.[1] Community-onset MRSA infections were caused by MRSA strains belonging to the genotypes USA300 and USA400 (identified by pulsed-field gel electrophoresis [PFGE]), also referred to as the community-associated MRSA (CA-MRSA) strains.[2,3] These CA-MRSA strains are associated with increased production of toxins and are less resistant to antimicrobial drugs than are traditional hospital-acquired MRSA (HA-MRSA) strains.[4,5] Although CA-MRSA strains usually cause mild skin and soft tissue infections, they can also cause severe and fatal disease.[6–8]
As the community prevalence of MRSA has risen,[9] more children colonized or infected with MRSA have been admitted to hospitals,[10–12] especially with phenotypic CA-MRSA strains. Notably, CA-MRSA strains can cause outbreaks in hospitals[13] and have become a frequent cause of hospital-onset infections.[14,15] Aside from ways to manage outbreaks[16] and a report that clinical cultures underestimate MRSA prevalence,[17] little is known about the prevalence of MRSA colonization of hospitalized children. The degree to which CA-MRSA strains are imported into and transmitted in high-risk settings such as pediatric intensive care units (PICUs) has not been determined. Understanding the effects of MRSA in hospitalized children is essential to guide, assess, and plan MRSA prevention and control programs among hospitalized children. Our objectives were to measure the prevalence of MRSA colonization at the time of admission to the PICU and to determine the effects of CA-MRSA strains on MRSA colonization, transmission, and hospital-acquired infections in the PICU.
