Daniel Glikman1. 1. Infectious Diseases Unit, Western Galilee Hospital Nahariya, Israel. danny.glikman@naharia.health.gov.il
Abstract
BACKGROUND: Community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infections were reported in the United States in the 1990's among healthy children, without traditional risk factors for infection with MRSA. CA-MRSA is now epidemic in the United States causing superficial infections and severe invasive disease. There is a paucity of data about CA-MRSA disease in the pediatric Israeli population and the common belief is that CA-MRSA disease is rare. OBJECTIVE: Prospective surveillance for CA-MRSA strains among hospitalized children at the Western Galilee Hospital in Israel over a 1-year period. METHODS: Staphylococcus aureus isolates were collected prospectively in 2007-8. CA-MRSA strains were defined as MRSA isolated in the first 72 hours of hospitalization with non-multi-drug resistant profile (resistant to < 3 non-beta-lactam antimicrobials). Patients' clinical characteristics were collected from medical charts. RESULTS: Five of 103 (4.8%) children were identified with Staphylococcus aureus isolates that were infected with CA-MRSA strains. All five had MRSA isolated from skin abscesses; their median age was 2.5 years. Skin and soft tissue infections were evident among 59 children infected with Staphylococcus aureus, 5 of which were CA-MRSA strains (8.5%). The calculated prevalence of CA-MRSA infections among pediatric patients within the study period was 76 cases per 100,000 admissions. All isolates were susceptible to vancomycin, linezolid, rifampin, trimethoprim sulfamethoxazole, and clindamycin. Four of the 5 children presented with recurrent MRSA infections. Possible risk factors for CA-MRSA were noted among 3 patients: participation in contact sports, atopic dermatitis, and family history of MRSA infections. CONCLUSIONS: A significant rate of CA-MRSA disease exists among children in the Western Galilee Region. CA-MRSA disease presents as recurrent skin and soft tissue infections. Awareness and recognition by culturing, mainly of skin lesions, is the first crucial step in investigating the magnitude of CA-MRSA disease. The old school thinking of MRSA being solely a hospital-based pathogen, in patients with frequent exposure to the healthcare system, is no longer valid in Israel.
BACKGROUND: Community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infections were reported in the United States in the 1990's among healthy children, without traditional risk factors for infection with MRSA. CA-MRSA is now epidemic in the United States causing superficial infections and severe invasive disease. There is a paucity of data about CA-MRSA disease in the pediatric Israeli population and the common belief is that CA-MRSA disease is rare. OBJECTIVE: Prospective surveillance for CA-MRSA strains among hospitalized children at the Western Galilee Hospital in Israel over a 1-year period. METHODS:Staphylococcus aureus isolates were collected prospectively in 2007-8. CA-MRSA strains were defined as MRSA isolated in the first 72 hours of hospitalization with non-multi-drug resistant profile (resistant to < 3 non-beta-lactam antimicrobials). Patients' clinical characteristics were collected from medical charts. RESULTS: Five of 103 (4.8%) children were identified with Staphylococcus aureus isolates that were infected with CA-MRSA strains. All five had MRSA isolated from skin abscesses; their median age was 2.5 years. Skin and soft tissue infections were evident among 59 children infected with Staphylococcus aureus, 5 of which were CA-MRSA strains (8.5%). The calculated prevalence of CA-MRSA infections among pediatric patients within the study period was 76 cases per 100,000 admissions. All isolates were susceptible to vancomycin, linezolid, rifampin, trimethoprim sulfamethoxazole, and clindamycin. Four of the 5 children presented with recurrent MRSA infections. Possible risk factors for CA-MRSA were noted among 3 patients: participation in contact sports, atopic dermatitis, and family history of MRSA infections. CONCLUSIONS: A significant rate of CA-MRSA disease exists among children in the Western Galilee Region. CA-MRSA disease presents as recurrent skin and soft tissue infections. Awareness and recognition by culturing, mainly of skin lesions, is the first crucial step in investigating the magnitude of CA-MRSA disease. The old school thinking of MRSA being solely a hospital-based pathogen, in patients with frequent exposure to the healthcare system, is no longer valid in Israel.
Authors: E Berla-Kerzhner; A Biber; M Parizade; D Taran; G Rahav; G Regev-Yochay; D Glikman Journal: Eur J Clin Microbiol Infect Dis Date: 2016-09-27 Impact factor: 3.267