Deborah Lehman, MD

Unlike the incidence in adults, incidence in children is on the rise, driven predominately by community-onset cases.

Both healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) infections and community-associated MRSA (CA-MRSA) infections are associated with high morbidity and mortality. Recent surveys demonstrate decreasing rates of both types of infections in adult populations, which may result from increased awareness of hospital-acquired infections and institution of measures to reduce central-line infections. Is the same true for MRSA in children?

Researchers report surveillance data for MRSA infections in children (aged <18 years) from nine U.S. metropolitan areas in 2005–2010. Cases of invasive MRSA infection were defined by isolation from sterile sites (blood, cerebrospinal fluid, pleural fluid).

Among 876 identified cases (mean age, 2.1 years; 59% male), 42% were considered CA-MRSA, 35% HA-MRSA, and 23% healthcare-associated community-onset (HACO) MRSA (cultures obtained in the outpatient setting in a patient with healthcare risk factors). Most children (91%) were hospitalized, and 6% (53 patients) died. Blood stream infections accounted for 79% of infections; other sources included bone and joint (20%), skin and soft tissue (17%), empyema (15%), and meningitis (4%). The strain predominantly responsible for CA-MRSA (USA300) was implicated in 54% of HA-MRSA and 63% of HACO-MRSA cases. The incidence of CA-MRSA infections increased 10% per year across all age groups, in seven of the nine surveillance sites, and overall rates were highest in black children and those aged 3–89 days. The incidence of HA-MRSA or HACO-MRSA did not change significantly, except for a decrease in late-onset infections in infants aged 3–89 days.

Citation(s):

Iwamoto M et al. Trends in invasive methicillin-resistant Staphylococcus aureus infections. Pediatrics 2013 Sep 23; [e-pub ahead of print].