Community-associated Methicillin-Resistant<i>Staphylococcus aureus</i>Strains in Pediatric Intensive Care Unit1

Milstone, Aaron M.; Carroll, Karen C.; Ross, Tracy; Shangraw, Kathryn; Perl, Trish M.

doi:10.3201/eid1604.090107

Cited by 48 publications

(49 citation statements)

References 37 publications

(48 reference statements)

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“…17,19 Our findings corroborate these data, since CA-MRSA isolates have been identified only in the anal and oropharyngeal sites.…”

supporting

confidence: 81%

“…isolates colonizing patients that are frequent users of healthcare services and with a serious underlying disease, with these factors having been pointed out in the literature as important risk factors for colonization with VRE. 17,23 When analyzing the positivity of the investigated sites, anal and oropharyngeal swabs showed a higher positivity rate for S. aureus, whereas nasal swabs yielded the highest positivity for Enterococcus spp., respectively 25%, 25% and 20%.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Enterococcus spp. and S. aureus colonization in neutropenic febrile children with cancer

Spinardi¹,

Berea²,

Orioli³

et al. 2017

GERMS

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Introduction Febrile neutropenia is one of the most serious treatment-related complications in cancer patients. Susceptible to rapidly progressing infections, which result in prolonged hospitalization and use of broad-spectrum antibiotics, neutropenic patients are subject to colonization by multiresistant agents, which enhances the risk of infections.Methods In this study we included samples collected with nasal, oropharyngeal and anal swabs from hospitalized children with febrile neutropenia following chemotherapy, between March 2014 and 2015, aiming to elucidate colonization by S. aureus and Enterococcus spp., as well as their resistance profile.Results S. aureus was found in 22% of the patients and 14% of the events. Methicillin-resistant S. aureus colonized 13.6% of patients. Including anal swabs in the screening increased the identification of colonized patients by 20%. Enterococcus spp. was found in 27% of patients and 17% of episodes.Enterococcal isolates resistant to vancomycin, accounting for 25% of the total, were not isolated in anal swabs at any time, with the oropharyngeal site being much more important. The rate of infection by Enterococcus spp. was 4.5% of all patients and 16% among the colonized patients. ConclusionEspecially in this population, colonization studies including more sites can yield a higher chance of positive results. Establishing the colonization profile in febrile neutropenic children following chemotherapy may help to institute an empirical antibiotic treatment aimed at antibiotic adequacy and lower induction of resistance, thereby decreasing the risk of an unfavorable clinical outcome.

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“…17,19 Our findings corroborate these data, since CA-MRSA isolates have been identified only in the anal and oropharyngeal sites.…”

supporting

confidence: 81%

mentioning

confidence: 99%

Enterococcus spp. and S. aureus colonization in neutropenic febrile children with cancer

Spinardi¹,

Berea²,

Orioli³

et al. 2017

GERMS

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“…Review of the reference lists of all the included articles yielded 1 additional eligible study. Among the 18 eligible studies, 2 had partially overlapping data, 24,25 and the maximum relevant information was extracted (Fig 1).…”

Section: Resultsmentioning

confidence: 99%

“…[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] The studies provided screening data on 19 722 neonatal and pediatric patients. More specifically, 11 studies reported data on 12 284 screened neonates in 12 NICUs, whereas 6 studies reported data on 7107 children hospitalized in 6 PICUs.…”

Section: Figurementioning

confidence: 99%

MRSA Colonization and Risk of Infection in the Neonatal and Pediatric ICU: A Meta-analysis

Zervou

Zacharioudakis

Ziakas³

et al. 2014

Pediatrics

102

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BACKGROUND AND OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of morbidity and mortality in NICUs and PICUs. Our objective was to assess the burden of MRSA colonization on admission, study the time trends, and examine the significance of MRSA colonization in this population. METHODS:PubMed and Embase databases were consulted. Studies that reported prevalence of MRSA colonization on ICU admission were selected. Two authors independently extracted data on MRSA colonization and infection. RESULTS:We identified 18 suitable articles and found an overall prevalence of MRSA colonization of 1.9% (95% confidence interval [CI] 1.3%-2.6%) on admission to the NICU or PICU, with a stable trend over the past 12 years. Interestingly, 5.8% (95% CI 1.9%-11.4%) of outborn neonates were colonized with MRSA on admission to NICU, compared with just 0.2% (95% CI 0.0%-0.9%) of inborn neonates (P = .01). The pooled acquisition rate of MRSA colonization was 4.1% (95% CI 1.2%-8.6%) during the NICU and PICU stay and was as high as 6.1% (95% CI 2.8%-10.6%) when the NICU population was studied alone. There was a relative risk of 24.2 (95% CI 8.9-66.0) for colonized patients to develop a MRSA infection during hospitalization. CONCLUSIONS:In the NICU and PICU, there are carriers of MRSA on admission, and MRSA colonization in the NICU is almost exclusively associated with outborn neonates. Importantly, despite infection control measures, the acquisition rate is high, and patients colonized with MRSA on admission are more likely to suffer a MRSA infection during hospitalization.

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“…CA-MRSA strains have most commonly been SCCmec type IV and Panton-Valentine leukocidin positive, while HA-MRSA strains have most commonly been SCCmec types I, II, and III and Panton-Valentine leukocidin negative. However, recent studies describing CA-MRSA strains in the hospital setting (17,27,33) suggest that clinical presentation and epidemiologic risk factors are no longer sufficient to reliably define molecular strain types. CA-MRSA infections have been demonstrated to be more common in children, especially children less than 2 years of age (12).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Risk Factor Analysis for Methicillin-Resistant Staphylococcus aureus Nasal Colonization in Children Attending Child Care Centers

et al. 2011

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Children attending child care centers (CCCs) are at increased risk for infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA). Nasal colonization often precedes infection, and MRSA colonization has been associated with increased infection risk. Community-associated MRSA (CA-MRSA) has caused increased MRSA infections in the general population, including children. Little is known about the frequency of MRSA nasal colonization in young children, particularly in those attending CCCs where disease transmission is common. We sampled the nares of 1,163 children in 200 classrooms from 24 CCCs in North Carolina and Virginia to assess S. aureus colonization. MRSA strains were molecularly analyzed for staphylococcal cassette chromosome mec (SCCmec) type, Panton-Valentine leukocidin status, and multilocus sequence type. A case-control study was performed to identify risk factors for MRSA colonization. We found that 18.1% children were colonized with S. aureus and 1.3% with MRSA. Molecular analysis of the MRSA strains identified 47% as CA-MRSA and 53% as health care-associated MRSA (HA-MRSA). Although two centers had multiple children colonized with MRSA, genotyping indicated that no transmission had occurred within classrooms. The case-control study did not detect statistically significant risk factors for MRSA colonization. However, MRSA-colonized children were more likely to be nonwhite and to have increased exposure to antibiotics and skin infections in the home. Both CA-MRSA and HA-MRSA strains were found colonizing the nares of children attending CCCs. The low frequency of colonization observed highlights the need for a large multicenter study to determine risk factors for MRSA colonization and subsequent infection in this highly susceptible population.

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Community-associated Methicillin-ResistantStaphylococcus aureusStrains in Pediatric Intensive Care Unit1

Abstract: Endemicity may lead to increased resistance and virulence.

Cited by 48 publications

References 37 publications

Enterococcus spp. and S. aureus colonization in neutropenic febrile children with cancer

Enterococcus spp. and S. aureus colonization in neutropenic febrile children with cancer

MRSA Colonization and Risk of Infection in the Neonatal and Pediatric ICU: A Meta-analysis

Prevalence and Risk Factor Analysis for Methicillin-Resistant Staphylococcus aureus Nasal Colonization in Children Attending Child Care Centers

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