MRSA Infection

MRSA: Risk Factors for Household Transmission

MRSA: Risk Factors for Household Transmission.

Investigators from Minnesota and the Centers for Disease Control and Prevention (CDC) conducted a study to estimate the prevalence of, and risk factors for, methicillin-resistant Staphylococcus aureus (MRSA) colonization among household contacts of children identified with community-acquired MRSA infections. Case-patients were identified by review of culture results from 12 Minnesota hospital laboratories between 2005 and 2007. Eligible case-patients were children with MRSA infection who had no prior history of hospitalization, surgery, dialysis, or residence in a long-term care facility within one year prior to infection; had no history of an indwelling

Poor Hygiene Practices Spur Child MRSA Infections in ICU

State investigation finds flaws in hospital routines: Health | Alaska news at adn.com.

In April, Providence asked state health officials for help with an outbreak of methicillin-resistant Staphylococcus aureus -- known as MRSA -- in the hospital's newborn intensive care unit, where infants, many of them born premature, receive specialized medical care. Mild infections were detected in 14 infants, the last of which was identified in mid-May, according to Wednesday's edition of the state's Epidemiology Bulletin. Another 34 babies were ultimately found to be carrying the bacteria but showed no signs of infection, the bulletin says. Observations of staff in the Providence newborn intensive care unit after the outbreak showed incorrect hand-washing and gown-wearing about 31 percent of the time, according to the bulletin.

College instructor fighting MRSA in play areas banned from McDonald’s

College instructor fighting bacteria banned from McDonald’s - Arizona News from The Arizona Republic.

Chandler resident Erin Carr Jordan got a morning surprise from McDonald’s this week and there were no eggs or muffins involved. It was a 7 a.m. hand-delivered letter from a lawyer prohibiting her from setting foot in eight Valley McDonald’s and threatening her with criminal trespassing charges if she did. The mother of four, a college instructor with a doctorate in developmental psychology, is on an unrelenting national crusade to clean up fast-food play areas, claiming the pathogens she found in them threaten children’s health.  The incident she believes spurred the lawyer’s letter happened during one of her repeat visits to a Gilbert McDonald’s. She said she discovered antibiotic-resistant Staphylococcus aureus, or MRSA, known to cause potentially life-threatening infections, in the restaurant’s PlayPlace.

MRSA presents treatment challenges in pediatric patients

MRSA presents treatment challenges in pediatric patients - - ModernMedicine.

Dermatologists, primary care physicians and emergency department physicians typically give two treatments, performing incision and drainage and prescribing antibiotics, when they see patients with skin and soft tissue infections where methicillin-resistant Staphylococcus aureus (MRSA) infection is present. This trend continues, despite recommendations from the Centers for Disease and Control and Prevention and the Infectious Diseases Society of America to perform only incision and drainage to treat MRSA infections in uncomplicated skin and soft tissue infections, according to the associate chief of dermatology at Phoenix Children's Hospital. "Most dermatologists and general physicians tend to 'double-dip,'" says Harper Price, M.D., dermatologist and fellowship director, Phoenix Children's Hospital. "We perform I and D (incision and drainage) and give antibiotics as well most of the time. The evidence in the literature clearly shows that incision and drainage is superior to antibiotics in uncomplicated cases — meaning those patients without systemic signs of illness or rapid progression of skin lesions, associated immunosuppression and extremes of age. "If you do both (treatments), it is no better than giving a placebo instead of an antibiotic," she says. "Incision and drainage is the hallmark of treatment, but I think we are all worried about these superbugs and a patient not doing well with incision and drainage and not following up (with a clinician)."

Characteristics of Invasive Staphylococcus aureus in United Kingdom Neonatal Units

Characteristics of Invasive Staphylococcus aureus in United... : The Pediatric Infectious Disease Journal.

Background: In industrialized countries, Staphylococcus aureus (SA) is a leading cause of late-onset neonatal sepsis. Methods: Culture-proven episodes were identified prospectively from neonatal units participating in the neonatal infection surveillance network. Demographic, risk factor, and outcome data were collected. Results: Between 2004 and 2009, there were 117 episodes of SA infections (including 8 methicillin-resistant SA) in 116 infants from 13 units. The median gestational age and birth-weight were 27 weeks (90% ≤37 weeks, 85% ≤32 weeks) and 850 g (90% ≤2500 g), respectively. The overall incidence was 0.6 per 1000 live births and 23/1000 in infants <1500 g. Most episodes (94%) occurred more than 48 hours after birth (late onset). There were 7 early-onset episodes (<48 hours) (median gestational age, 38.5 weeks), all due to methicillin-susceptible SA. At the time of culture, 67 of 95 (71%) infants were receiving respiratory support and 47 of 94 (50%) had a central line in situ. The majority of infants had nonspecific clinical features although evidence of focal infection (skin, soft tissue, bone, joint, or pneumonia) was ultimately seen in 41 of 91 (45%). There were 18 deaths, 4 (all late onset) directly due to methicillin-susceptible SA sepsis (4.4%). Conclusions: SA is the second most common pathogen causing late-onset neonatal infections in this neonatal network. Infants who weigh <1500 g in intensive care settings are the most vulnerable group. Clinical signs are not sufficiently distinctive to allow targeted therapy, suggesting that an antistaphylococcal agent should be part of empiric therapy for late-onset sepsis in premature infants.

Antibiotic exposure a risk for pediatric MRSA

Controversies in Hospital Infection Prevention: Antibiotic exposure a risk for pediatric MRSA.

They found that 53% of cases and 14% of controls had prior antibiotic exposure. So, 47% of MRSA cases in children occurred without recent antibiotic exposure. After multivariable analysis, the adjusted OR for exposure to any antibacterial was 3.5 (95% CI 2.6-4.8). As an example of a nice dose-response curve, the ORs increased with the number of prescriptions with a OR of 2.2, 3.3, 11.0 and 18.2 for 1, 2, 3, and more than 4 prescriptions, respectively.

Carriage of MRSA : Incidence and Outcomes in Pregnant Women

Nasopharyngeal Carriage of Methicillin-Resistant Staphylococcus aureus: Incidence and Outcomes in Pregnant Women -- Patel and Kaufman 111 (6): 389 -- Journal of the American Osteopathic Association.

Results: Of 1045 patients who were tested, 31 patients (2.9%) had positive results for MRSA. By comparison, the hospital-wide MRSA prevalence for this period was 7.9% (569 positive results of 7206 patients tested). This prevalence was substantially higher than that noted for the study population. Twenty-three of the 31 patients (74%) delivered at our institution and thus comprised the study group. A control group comprised 46 patients with negative results of MRSA screening. No positive results of neonatal MRSA screening tests were noted in either group, and no statistically significant difference between the 2 groups existed in 5-minute Apgar scores, neonatal intensive care unit admissions, or neonatal sepsis evaluations. Positive MRSA-screening test results were associated with a statistically significant decrease in the provision of regional anesthesia to the pregnant women (P=.05). Conclusion: Maternal nasopharyngeal carriage of MRSA was not associated with adverse maternal or neonatal outcomes, including neonatal MRSA carriage. Regional anesthesia was provided less frequently to MRSA-positive individuals. Further studies in larger groups of patients are needed to help determine the optimal management of MRSA-positive patients during pregnancy.

Septic arthritis: staph an increasing cause

Causative organisms and their antibiotic resistanc... [Orthopedics. 2011] - PubMed result.

The goal of this study was to evaluate the array of causative organisms for septic arthritis in children and their antibiotic resistance patterns over a 20-year period at a single medical center. The medical records of children younger than 16 years with septic arthritis admitted to a hospital in China from 1989 to 2008 were retrospectively reviewed. A total of 158 cases of septic arthritis were studied, 70 from 1989 to 1998 and 88 from 1999 to 2008.Between the first and second decades, occurrence of serious illnesses decreased significantly from 44.3% to 28.4% (P<.04). The positive percentage was only 55.6% in the first decade and 44.82% in the second decade. The causative organisms of major significance between the 2 decades changed little, except methicillin-resistant Staphylococcus aureus (MRSA) increasing significantly. Staphylococci remained the major causative organisms for joint infection. The percentage of Staphylococcus aureus resistance to various antibiotics increased: 85% to 100% for penicillin, 58.8% to 75% for erythromycin, 0% to 31.3% for cefazolin, and 15% to 29.4% for multi-resistance. In the second decade, 4 MRSA stains were multi-resistant. However, gentamincin resistance remained at the same level.

MRSA and day care: what are the risks

Prevalence and Risk Factor Analysis for Methicillin-Resistant Staphylococcus aureus Nasal Colonization in Children Attending Child Care Centers -- Miller et al. 49 (3): 1041 -- Journal of Clinical Microbiology.

We sampled the nares of 1,163 children in 200 classrooms from 24 CCCs in North Carolina and Virginia to assess S. aureus 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.

Pediatricians briefed on child community MRSA

Staph skin infections creeping into communities -- Korioth 32 (3): 25 -- AAP News.

The AAP advises that children who show signs of a skin infection, such as a red, hot or swollen wound on their skin or one that is draining pus, have it examined by their pediatrician. Skin bumps and wounds that are taking a long time to disappear also should be checked. To prevent the spread of MRSA, the AAP suggests the following: Encourage children to practice good hygiene by washing hands frequently with soap and warm water for 15-20 seconds or using hand sanitizers.... Read More at the link above

MRSA ST97 Among Newborns

Detection and characterization of ST97-SCCmecV Com... [J Med Microbiol. 2011] - PubMed result.

A total of 29 methicillin-resistant Staphylococcus aureus isolates were obtained from 15 neonates, three health care workers (HCW) in a neonatal intensive care and special care babies unit and four patients in a medical ward of a Kuwait hospital between 10 and 30 April 2007. The isolates were characterized using antibiogram, coagulase gene restriction fragment length polymorphism (coa-RFLP), pulsed field gel electrophoresis (PFGE), Staphylococcal cassette chromosome mec (SCCmec) typing and multilocus sequence typing (MLST). All isolates were assessed for the carriage of genes for Panton Valentine leukocidin (PVL) and arginine catabolic mobile element (ACME). The isolates belonged to three SCCmec types, six coa-RFLP, six pulsotypes and six sequence types. One isolate was positive for PVL. None was positive for ACME. All MRSA isolates from the 15 neonates were phenotypically and genetically different from MRSA isolates obtained from HCW and those from patients in other wards. They were resistant to gentamicin, kanamycin and fusidic acid, had identical coa-RFLP and PFGE patterns, carried the type V SCCmec element and belonged to MLST sequence type (ST97). The results shows the transmission of a rare clone of CA-MRSA belonging to sequence type (ST97) with SCCmec-V genotype among neonates in a neonatal intensive care and special care baby units.

Part of day care closed after staph infection

Part of day care closed after staph infection  - News - Charleston Daily Mail - West Virginia News and Sports -.

The infant room at the West Virginia Public Employees Day Care on Jefferson Street near the Capitol was closed Tuesday after at least one child at the center was diagnosed with MRSA. MRSA, or methicillin-resistant staphylococcus aureus, is a highly contagious staph infection that is resistant to some antibiotics, such as penicillin, according to the Centers for Disease Control and Prevention website. It can lead to other ailments and in some cases can be fatal, said Dr. Rahul Gupta, executive director of the Kanawha-Charleston Health Department. However, most cases of MRSA, especially the kind contracted in the community and not in hospitals, do not reach that level, he said. "Fortunately the most common versions of MRSA we see in the community are not the worst kind," Gupta said. That section of the day care will reopen today. Employees have disinfected the infant room with bleach and other cleaning supplies, said Danny Webb, director of Community Education for Kanawha County Schools, which runs the Public Employees Day Care.

Evidence-based guidance issued for treating MRSA infections in Children

Evidence-based guidance issued for treating MRSA infections -- Jackson 32 (2): 1 -- AAP News.

The guideline includes 77 recommendations. The main points related to the care of children are outlined below. The most important principle in treating this common skin infection is to drain the abscess. A retrospective study and a pediatric randomized controlled trial showed that in skin and soft tissue infections, drainage alone of abscesses less than 5 centimeters (cm) is as effective as drainage plus antibiotics. Antibiotic therapy in addition to drainage should be used in the following settings: * abscesses greater than 5 cm; * ill appearing child (as evidenced by fever, etc.); * abscess site that is difficult to drain (e.g., genitalia, face, hands); * children with co-morbidities (e.g., chronic underlying disease, immunosuppressed); * rapidly advancing disease; and * failure of simple drainage. A culture of purulent material should be obtained before antimicrobial therapy is initiated. For children with simple skin or soft tissue infection, oral antibiotic options include clindamycin, trimethoprim-sulfamethoxazole (TMP/SMX), doxycycline (for those older than 8 years) or linezolid.

Containing MRSA on a neonate ward

SpringerLink - European Journal of Clinical Microbiology & Infectious Diseases, Online First™.

We report an MRSA outbreak in our 25-bed tertiary neonatal intensive care unit (NICU), which was successfully contained. Methods include a retrospective review of patient files, microbiology records and meeting protocols. During the seven months of outbreak, 27 patients and seven health care workers (HCWs) had positive cultures for MRSA. The outbreak was caused by the epidemic Rhine-Hessen strain; cultured isolates were monoclonal. After a sharp increase of the number of new MRSA-cases the installation of an outbreak management team (OMT) and implementation of comprehensive measures (extensive screening and decolonization strategy including orally applied vancomycin, isolation wards, intensive disinfection regimen) successfully terminated the outbreak within one month. Ten (53%) of 19 patients with completed follow-up and all of the HCWs were decolonized successfully. Gastrointestinal colonization was present in 15 of 27 (56%) neonates, and was associated with poor decolonization success (30% vs. 78% in absence of gastrointestinal colonization). A comprehensive outbreak management can terminate an outbreak in a NICU setting within a short time. Thorough screening of nares, throat and especially stool is necessary for correct cohorting. Gastrointestinal decolonization in neonates seems difficult.

Daptomycin. MRSA and new borns

Successful treatment of meticillin-resistant Staphylococcus aureus bacteraemia in a neonate using daptomycin -- Hussain et al., 10.1099/jmm.0.027235-0 -- Journal of Medical Microbiology.

Daptomycin is licensed for the management of Staphylococcus aureus infections in adults, including MRSA. Little data exists on pediatric use or dose guidance in neonates. We report the case of a neonate with MRSA bacteremia successfully managed with daptomycin. Dose requirements were substantially higher than those recommended for adults.

Day Care and larger families spread CA MRSA

Factors associated with nasal colonization of methicillin-resistant Staphylococcus aureus among healthy children in Taiwan -- CHEN et al., 10.1128/JCM.01774-10 -- Journal of Clinical Microbiology.

The overall prevalence of MRSA and S. aureus carriage were 7.8% and 23.2%, respectively. A majority (88%) of MRSA isolates belonged to a common Asian Pacific CA-MRSA lineage, multi-locus sequence type 59, and were resistant to multiple non-beta-lactam antibiotics. The carriage rate of MRSA was higher among subjects 2-6 months old (p<0.0001), residing in northern Taiwan (p=0.0003), and enrolled later in the study (p<0.0001). MRSA colonization was associated with number of children in the family (adjusted odds ratio [aOR] 1.114, 95% confidence interval [CI] 1.002-1.240, p=0.0463) and day-care attendance (aOR 1.530, 95% CI 1.201-1.949, p=0.0006). Breast feeding (p<0.0001) and colonization with S. pneumoniae (p=0.0170) were protective against MRSA colonization. We concluded that epidemic CA-MRSA strains increasingly colonized Taiwanese children between 2005 and 2008. The carriage rate varied significantly across different demographical features. Crowding was an independent environmental risk factor which might accelerate CA-MRSA transmission in the community.

Pediatric Skin Abscessesm - Why drugs not always the answer

Are Antibiotics Indicated for Pediatric Skin Abscesses? : Advanced Emergency Nursing Journal.

Review of recent evidence with translation to practice for the advanced practice nurse role is presented using a case study module for “Randomized, controlled trial of antibiotics in the management of community acquired skin abscesses in the pediatric patient.” The study results showed that antibiotics were not necessarily associated with better wound resolution than incision and drainage alone. The implications and clinical relevance of these findings for advanced practice nurses are discussed highlighting best evidence.

Children carrying multiple strains of MRSA and Staph

Simultaneous Carriage of Multiple Genotypes of Staphylococcus aureus in Children -- Mongkolrattanothai et al., 10.1099/jmm.0.025841-0 -- Journal of Medical Microbiology.

Co-existence of multiple genotypes in Staphylococcus aureus colonization has not been fully investigated. The aim of this study was to evaluate the heterogeneity of S. aureus carriage in children. We evaluated 125 nasal and perianal swab samples from 76 children scheduled for elective surgery who were positive for S. aureus. For each sample, at least 4 colonies with the same or different morphotypes were selected for analysis. Multiple-locus variable number of tandem repeat fingerprinting was used to determine the genetic relatedness and characterize the clonality of S. aureus strains. Of the 125 swabs, 91 (73%) swabs contained MSSA, 8 (6%) swabs contained MRSA, and 26 (21%) swabs contained MSSA and MRSA simultaneously. A total of 738 S. aureus strains were evaluated with a mean of 6 colonies (range 4-15) picked from each culture. Of the 125 swabs, 32 (25%) samples contained two genetically distinct S. aureus strains and 6 (5%) contained three different genotypes. Multiple S. aureus strains simultaneously carried by the individual children were genetically unrelated to each other. Conclusions: Co-existence of multiple genotypes of S. aureus was common. The significance of multiple carriage is yet to determined, this intraspecies interplay could lead to the differences in pathogenicity and virulence in S. aureus.

25 times more Community MRSA cases among children

Emergence of community-acquired methicillin-resistant Staphylococcus aureus skin and soft tissue infections as a common cause of hospitalization in United States children.

These data represent 616,375 pediatric discharges for skin and soft tissue infections from U.S. hospitals between 1996 and 2006. This represents approximately 69.9 hospitalizations for skin and soft tissue infections per 100,000 U.S. children per year. Staphylococcus aureus and CA-MRSA accounted for 19.6% and 9.6% of these cases, respectively. The rate of hospitalization for CA-MRSA skin and soft tissue infections increased dramatically over the study period; from less than one case per 100,000 in 1996 to 25.5 cases per 100,000 in 2006. Rates of CA-MRSA varied by region, with the South region having the highest rate (11.5 per 100,000 US children), followed by the West (5.2), Northeast (3.4), and Midwest (3.2). Peak CA-MRSA incidence occurred from May to December; however, the incidence in the South region was consistently higher than other regions for most months and the period of peak incidence was longer than other regions. Independent risk factors for CA-MRSA included survey year, race, geographic region, hospital size, and health insurance status (P < .0001 for all risk factors).

MRSA in Newborns - The Statistics

Neonatal infections in England: the NeonIN surveillance network -- Vergnano et al. -- ADC - Fetal and Neonatal Edition.

Results With the inclusion of coagulase negative Staphylococci (CoNS), the incidence of all neonatal infection was 8/1000 live births and 71/1000 neonatal admissions (2007–2008). The majority of infections occurred in premature (<37 weeks) and low birthweight (<2500 g) infants (82% and 81%, respectively). The incidence of early onset sepsis (EOS; ≤48 h of age) was 0.9/1000 live births and 9/1000 neonatal admissions, and group B Streptococcus (58%) and Escherichia coli (18%) were the most common organisms. The incidence of late onset sepsis (LOS; >48 h of age) was 3/1000 live births and 29/1000 neonatal admissions (7/1000 live births and 61/1000 admissions including CoNS) and the most common organisms were CoNS (54%), Enterobacteriaceae (21%) and Staphylococcus aureus (18%, 11% of which were methicillin resistant S aureus). Fungi accounted for 9% of LOS (72% Candida albicans). The majority of pathogens causing EOS (95%) and LOS (84%) were susceptible to commonly used empiric first line antibiotic combinations of penicillin/gentamicin and flucloxacillin/gentamicin, respectively (excluding CoNS).