MRSA Infection & Symptoms

Enhanced surveillance of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in children in the UK and Ireland -- Johnson et al., 10.1136/adc.2009.162537 -- Archives of Disease in Childhood

Enhanced surveillance of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in children in the UK and Ireland -- Johnson et al., 10.1136/adc.2009.162537 -- Archives of Disease in Childhood.

Results: 265 episodes of MRSA bacteraemia were ascertained, involving 252 children. The overall incidence rate was 1.1 per 100,000 child population per year (95%CI 0.9-1.2): 61% of the children were aged <1 year (a rate of 9.7 cases per 100,000 population per year [95% CI 95% CI 8.2 – 11.4]) and 35% were <1 month. Clinical data were obtained from 115 cases. The clinical presentation varied, with fever present in only 16% of neonates compared with 72% of older children. A history of invasive procedure was common, with 32% having had intravascular lines and 13% having undergone surgery. Sixty-two per cent of patients for whom data were available were receiving high-dependency care (46% in SCBU/NICU and 16% in PICU). Of 93 MRSA isolates studied, 73% belonged to epidemic strains widely associated with nosocomial infection in the UK and Ireland. Conclusions: MRSA bacteraemia in children was relatively uncommon and was predominantly seen in very young children, often those receiving neonatal or paediatric intensive care. Bacteraemia predominantly involved well documented epidemic strains of MRSA associated with nosocomial infection.

Blackburn baby unit MSSA superbug spotted by ‘vigilance’

Blackburn baby unit superbug spotted by ‘vigilance’ (From Blackburn Citizen).

HEALTH bosses have said how ‘constant vigilance’ helped them identify a superbug in the neonatal intensive care baby unit. Seven children contracted MSSA – methicillin sensitive staphylococcus aureus – at Blackburn Royal Hospital, leading to admissions being limited. MSSA is bacteria found commonly on the skin and can be treated with anti-biotics. If it turns into an infection in the bloodstream it can cause serious illness. The babies have the bacteria on their skin – but it is not in their blood-streams, and none are currently ill, according to hospital chiefs. They are being treated in isolation and may remain in hospital for several weeks to ensure they are free of the bacteria. Rineke Schram, director of infection control for East Lancashire Hospitals NHS Trust, said the superbug had been caught at a very early stage thanks to the hospital’s screening processes.

MRSA & Children - The key facts

Given the fearsome reputation of MRSA many parents are deeply concerned when a diagnosis of MRSA is given to one of their children.

The drug resistant version of the common staph (SA) infection has spread rapidly among children since the turn of the century and in some cities and countries is thought to infect up to 10% of children in the population.(SA is carried by up to 30%) For many an MRSA infection will be a rare but not threatening event, for some it will be a source of chronic infection and illness. MRSA, in many cases will not be more deadly than SA, just harder and more expensive to treat. It also makes those with health challenges more vulnerable to complications.

A child catches MRSA through a number of sources.

Some very young children catch MRSA during the childbirth process. They carry the bacteria but many do not become ill. It can however become a problem for a child with early life health complications. Sources of the infection can include the mother - who may be a carrier, and can happen during the birth as MRSA bacteria can be found in the groin area. Another mother might also trigger an infection on the ward. There is always the possibility that staff might be carriers or cross infect via their hands. Read More

Domestic infection via a family member is also a potential source. A family member become an MRSA carrier with no symptoms. Every day contact, shared items and family pets can become part of the pattern of infection inside the family as the bacteria is deposited on surfaces, pets and human skin. Regular patterns of hand washing inside infected families as well as special soaps can all help minimise spread of the bacteria and risk of wound infection. Read More

As the child grows older and is perhaps cared for in a day care context there will often be a great deal of casual contact with other children. This can be the context for the slow spread of MRSA and the gradual replacement of SA as one of the dominant bacteria on the skin of up to 30% of the children. If the day care centre does not have a very pro-active hand washing policy MRSA can take hold among the children. Read More  

More to come - page being written

One in ten children in intensive care have MRSA

One in ten children in intensive care have MRSA.

Around 100 new patients on PICU have been screened using the new rapid polymerase chain reaction (PCR) test for MRSA – and 10% were carriers. Natalie Edwards, senior sister in PICU, said: 'We would have normally only known that these children carried MRSA once they had an infection. Now we know which ones are carriers we can quickly get them into treatment, with isolation and eradication. That way we can minimise cross-contamination.' Children's hospitals are not subject to Department of Health requirements to screen all elective admissions for MRSA from next March.

New Borns catching MRSA during birth

Emergence of and Risk Factors for Methicillin-Resistant Staphylococcus aureus of Community Origin in Intensive Care Nurseries -- Seybold et al. 122 (5): 1039 -- Pediatrics.

Between 1993 and 2006, 130 (3.5%) of 3707 infants were identified to be colonized with methicillin-resistant S aureus. Twelve (1.2%) of 996 admission nares cultures were positive for methicillin-resistant S aureus (since initiation of admission cultures in September 2004). Community-acquired methicillin-resistant S aureus clones were first recovered in 1998; the proportion of methicillin-resistant S aureus clones of community origin increased significantly between 1998 and 2004. Multivariate analysis identified vaginal delivery and maternal smoking, both among infants of mothers receiving systemic antibiotic treatment before delivery, as independent predictors for neonatal colonization with community-acquired methicillin-resistant S aureus. Systemic antibiotic therapy before delivery for nonsmoking mothers delivering through cesarean section and possibly endotracheal intubation were associated with the recovery of health care-associated methicillin-resistant S aureus clones. CONCLUSIONS. Community-acquired methicillin-resistant S aureus clones have emerged as a major cause of methicillin-resistant S aureus colonization in high-risk newborns. Community-acquired methicillin-resistant S aureus recovery was associated with acquisition during birth, whereas health care-associated methicillin-resistant S aureus clones seemed to be transmitted nosocomially.

Babies develop MRSA rashes at Yonkers hospital

Babies develop MRSA rashes at Yonkers hospital | lohud.com | The Journal News.

Seven babies born recently at St. John's Riverside Hospital have developed staph infections, also known as MRSA, hospital officials announced today. The newborns have skin rashes and no serious illnesses related to the bacteria have been reported, the officials said.  The hospital has tested 100 members of its maternity nursing staff in an effort to identify the source of the bacteria.

Flu & MRSA as child killer

Link: Effect Measure : Flu as child killer.

Staph pneumonia is not a new phenomenon; from 3% to 10% of pneumonias that begin outside hospitals have been attributed to staph, but those pneumonias tend to occur in the elderly and immune-impaired. And the severity of simultaneous staph and flu infections has been documented after each influenza pandemic, in which large numbers of deaths were attributed to bacterial pneumonia. But the staph pneumonias recorded by the new reporting system represent an apparently new development, because they occurred in previously healthy children infected with a seasonal flu virus that presumably does less damage to the lungs and immune response than a novel pandemic one. And they appear to be occurring at the same time as a rapid rise in MRSA colonization in the United States, which doubled between 2001 and 2004. (Maryn McKenna, CIDRAP News)

MRSA deaths from Influenza jump 500% in 3 years

Link: Influenza-Associated Pediatric Mortality in the United States: Increase of Staphylococcus aureus Coinfection -- Finelli et al. 122 (4): 805 -- Pediatrics.

RESULTS. During the 2004–2007 influenza seasons, 166 influenza-associated pediatric deaths were reported (n = 47, 46, and 73, respectively). Median age of the children was 5 years. Children often progressed rapidly to death; 45% died within 72 hours of onset, including 43% who died at home or in an emergency department. Of 90 children who were recommended for influenza vaccination, only 5 (6%) were fully vaccinated. Reports of bacterial coinfection increased substantially from 2004–2005 to 2006–2007 (6%, 15%, and 34%, respectively).  Influenza-associated pediatric mortality is rare, but the proportion of S aureus coinfection identified increased fivefold over the past 3 seasons. Research is needed to identify risk factors for influenza coinfection with invasive bacteria and to determine the impact of influenza vaccination and antiviral agents in preventing pediatric mortality.

4% of Japanese children CA MRSA positive

Link: Extreme genetic diversity of methicillin-resistant Staphylococcus epidermidis (MRSE) disseminated among healthy Japanese children -- Jamaluddin et al., 10.1128/JCM.02262-07 -- Journal of Clinical Microbiology.

For the past few years, we have been observing the dissemination of methicillin-resistant staphylococci in the community. In the period of 2001 to 2003, evaluation of nasal samples of 1,285 children of five day-care centers and two kindergartens in three districts in Japan revealed that methicilin-resistant coagulase-negative staphylococci (MRC-NS) have been widely disseminated in the Japanese community. Its prevalence is much greater than community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Forty nine children (3.81%) were colonized with methicillin-resistant Staphylococcus aureus (MRSA), whereas 390 children (30.35%) were colonized with MRC-NS. These MRC-NS strains predominantly harbored a pair of cassette chromosome recombinases types A2 and B2 (ccrAB2). Of these, 40.8% harbored type IVa SCCmec elements, a distinct/characteristic SCCmec in pandemic clones of CA-MRSA. Interestingly, there was also a high frequency of non-typeable (NT) strains which possessed atypical structures as compared to previous SCCmec types. Among the MRC-NS, the majority of strains (63.59%) were methicillin-resistant Staphylococcus epidermidis (MRSE). Their genotypes as judged from pulsed field gel electrophoresis (PFGE) were highly diverse. It was so diverse that there was no sign of immediate transmission of any MRSE clone among children of the same institutions. In a previous report we expounded that a few CA-MRSA clones with distinct SCCmec types were disseminated among children of the same institutions. Au contraire, with the case of CA-MRSE, there was no single genotype of CA-MRSE disseminated among children even in the same institution or class.

MRSA linked to cot death

Link: Medical Laboratory World.

AUSTRALIAN scientists claim they have found evidence suggesting a link between a bacteria infection similar to MRSA and cot death. Researchers at The Women’s and Children’s Hospital and the University of Adelaide analysed the post mortem reports of 130 babies who had died of Sudden Infant Death Syndrome (SIDS) together with 32 from youngsters who had died suddenly as a result of infection, and another 33 who died of non-infectious causes such as accidents. The team then studied bacteria from sterile sites within the bodies which are normally free of infection, such as the heart, blood or spleen. It was of little surprise to find that infection of a sterile site where there had been no infection before death was unusual. However, they did discover that infection of these parts was common in babies who had died of SIDS. And, in many of the cases, there were signs of S. aureus infection, a particularly-virulent bacteria similar to the hospital ‘superbug’ MRSA.

High prevalence in cystic fibrosis patients of multiresistant MRSA

Link: High prevalence in cystic fibrosis patients of multiresistant hospital-acquired methicillin-resistant Staphylococcus aureus ST228-SCCmecI capable of biofilm formation -- Molina et al., 10.1093/jac/dkn302 -- Journal of Antimicrobial Chemotherapy.

Conclusions: Distinct microbiological and molecular features were detected among CF-MRSA isolates, probably due to adaptation to specific conditions in CF patients. Prevalence of MRSA increased among these patients, most of them colonized with a multiresistant biofilm-forming clone belonging to ST228-SSCmecI, suggesting cross-transmission or a common source.

MRSA Impact on Chidren Worsening

Link: HighWire Press -- Medline Abstract.

RESULTS:: Two hundred ninety children (60% male subjects) with acute osteomyelitis were identified. Median (25th-75th percentile) age at diagnosis was 6 years (range, 2-11 years). Significant clinical findings included the following: localized pain (84%), fever (67%), and swelling (62%). Affected bones included the following: foot (23%), femur (20%), tibia (16%), and pelvis (7%). Thirty-seven percent of blood cultures were positive, and a bacterial isolate was obtained in 55% of cases. Bacteria most frequently isolated included the following: methicillin-sensitive S. aureus (45%) (57% in period Avs 40% in period B), MRSA (23%) (6% in A vs 31% in B; P < 0.001), Streptococcus pyogenes (6%), and Pseudomonas aeruginosa (5%). Children with MRSA compared with those with non-MRSA osteomyelitis had significantly greater erythrocyte sedimentation rate and C-reactive protein values on admission and increased length of hospital stay, antibiotic therapy, and overall rate of complications. We observed significant changes in antibiotic therapy related to increased use of agents with activity against MRSA. CONCLUSIONS:: Methicillin-resistant S. aureus was isolated more frequently in the second study period and was associated with worse clinical outcomes. LEVEL OF EVIDENCE:: II. Retrospective study.

Babies Isolated For Colonised MRSA Outbreak

Link: Babies Isolated For Colonised MRSA Outbreak (from The Herald ).

Five newborn babies on an intensive care ward have been isolated after the MRSA bug was found on their skin. Another seven babies in the unit who were unaffected by the outbreak were immediately moved to temporary accommodation at the Royal Alexandra Hospital in Paisley to prevent the bug from spreading. The five affected infants are being looked after in isolation in the hospital's special care baby unit. None has been infected by the bug but they have colonised MRSA, which means the bacteria has simply lodged on their skin. Most people with colonised MRSA experience no symptoms and require no treatment.

Baby ward cleared of superbug

Link: Baby ward cleared of superbug - ABC News (Australian Broadcasting Corporation).

The Newborn Care Centre at Sydney's Royal North Shore Hospital has reopened its doors after five babies tested positive to an antibiotic-resistant superbug. The babies were isolated more than a week ago, after doctors found the MRSA bacteria on their skin or inside their noses. The hospital says none of the babies became ill but the centre was closed to new admissions as a precaution. A hospital spokeswoman says there have been no new infections and the ward has been back to normal since Friday night. The MRSA superbug can be transferred between patients when hospital staff do not follow proper sanitary procedures.

The MRSA time bomb growing among children

Link: 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 -- Fritz et al. 121 (6): 1090 -- Pediatrics.

OBJECTIVE. We sought to define the prevalence of and risk factors for methicillin-resistant Staphylococcus aureus nasal colonization in the St Louis pediatric population. METHODS. Children from birth to 18 years of age presenting for sick and well visits were recruited from pediatric practices affiliated with a practice-based research network. Nasal swabs were obtained, and a questionnaire was administered. RESULTS. We enrolled 1300 participants from 11 practices. The prevalence of methicillin-resistant S aureus nasal colonization varied according to practice, from 0% to 9% (mean: 2.6%). The estimated population prevalence of methicillin-resistant S aureus nasal colonization for the 2 main counties of the St Louis metropolitan area was 2.4%. Of the 32 methicillin-resistant S aureus isolates, 9 (28%) were health care-associated types and 21 (66%) were community-acquired types. A significantly greater number of children with community-acquired methicillin-resistant S aureus were black and were enrolled in Medicaid, in comparison with children colonized with health care-associated methicillin-resistant S aureus. Children with both types of methicillin-resistant S aureus colonization had increased contact with health care, compared with children without colonization. Methicillin-sensitive S aureus nasal colonization ranged from 9% to 31% among practices (mean: 24%). The estimated population prevalence of methicillin-sensitive S aureus was 24.6%. Risk factors associated with methicillin-sensitive S aureus colonization included pet ownership, fingernail biting, and sports participation. CONCLUSIONS. Methicillin-resistant S aureus colonization is widespread among children in our community and includes strains associated with health care-associated and community-acquired infections.

HIV Children Very Vulnerable to Infection

Link: HighWire Press -- Medline Abstract.

Seventy-seven percent of S. aureus were MRSA. Carriage of resistant organisms was not associated with hospitalization. On multivariate logistic regression, risk factors for colonization with Enterobacteriaceae were age below one year (Odds ratio 4.4; 95% Confidence Interval 1.9-10.9; p = 0.0008) and CDC stage C disease (Odds ratio 3.6; 95% Confidence Interval 1.5-8.6; p = 0.005) Nineteen (9.4%) subjects had 23 episodes of bacteremia. Enterobacteriaceae were most commonly isolated (13 of 25 isolates), of which 6 (46%) produced ESBL and were resistant to gentamicin. CONCLUSIONS: HIV-infected children are colonized with potential pathogens, most of which are resistant to commonly used antibiotics. TMP-SMX resistance is extremely common. Antibiotic resistance is widespread in colonizing organisms and those causing invasive disease. Antibiotic recommendations should take cognizance of resistance patterns. Antibiotics appropriate for ESBL-producing Enterobacteriaceae and MRSA should be used for severely ill HIV-infected children in our region. Further study of antibiotic resistance patterns in HIV-infected children from other areas is needed.

In memory of Maddy: MRSA claims life of two month old

Link: In memory of Maddy :: Naperville Sun :: Lifestyles.

Thirty-six hours before Madeline Reimer stopped breathing, her mother snapped a photo of the newborn, sleeping serenely on a pastel blanket in the summer of 2005. Displayed in the stairway of her Plainfield home, it's one of the only photos of her with her eyes closed. In most others, her big, dark eyes are focused on her twin brother, Luke. Her mother, Beth Reimer, looks more closely at the photo today. Maddy's tiny nostrils are flared - possibly because she was struggling to breathe, Beth said. Her parents and her pediatrician thought she had a cold at the time, but a strain of drug-resistant bacteria was eating away at her lungs.

MRSA Children Should Get Flu Shots

Link: State: Flu bug is hitting hard here.

Is anything different about this year's flu? Many cases seem shorter, but more severe, Sinnott said. Health officials also are watching for bacterial infections following the flu, often the most deadly complication of the disease. Last year, Florida had a few cases of flu-associated pneumonia caused by MRSA, a type of staph bacteria that is resistant to most antibiotics. Doctors will be watching for that closely this year. Dumois has advised families where children have had MRSA infections to get flu shots.

Child At Day Care Diagnosed With MRSA

Link: Child At Day Care Diagnosed With MRSA - Orlando News Story - WKMG Orlando.

A child who attends a Central Florida day care has been diagnosed with methicillin-resistant Staphylococcus aureus infection, more commonly known as MRSA, according to officials. The infection, caused by Staphylococcus aureus bacteria or staph, was discovered in a room for 2 year olds at Kids-R-Kids in Waterford Lakes, officials said.

Circumcision Increases MRSA Risk by 12

Link: Circumcision Increases MRSA Risk - Associated Content.

Boys who are circumcised now have a 12 times higher risk of contracting MRSA than those who are left intact. Newborns immune systems are developing and immature in many aspects. Once they have an open wound, the risk is that much higher. Circumcisions are often done in hospitals where MRSA circulates. Surgical tools are used for the procedure and while they are hopefully adequately sanitized, the increased chance of bacteria entering a fresh opening into the body makes MRSA more likely to invade.