Shahin R, Johnson I L, Jamieson F, McGeer A, Tolkin J, Ford-Jones E L
Toronto Public Health Department, University of Toronto, Ontario, Canada.
Arch Pediatr Adolesc Med. 1999 Aug;153(8):864-8. doi: 10.1001/archpedi.153.8.864.
To study the prevalence of methicillin sodium-resistant and methicillin-sensitive Staphylococcus aureus colonization in a child care center following the diagnosis of community-acquired methicillin-resistant S. aureus (MRSA) disease in a previously well 2 1/2-year-old attendee and to determine the optimal site of detection of S. aureus.
Point prevalence survey and questionnaire administration.
A Toronto, Ontario, child care center.
Parents were provided with general information. Consenting parents completed a questionnaire and permitted screening of their child at 1 or more of throat, nose, and perianal sites. Families of children who were culture positive for MRSA were offered screening and suppressive therapy. Nasal and perianal swabs were obtained from child care center staff and screened.
Of 201 children, 164 (81.6%) had completed questionnaires and had undergone screening at 1 or more sites; 38 staff members (100%) completed questionnaires and were screened. A 26-month-old classroom contact with chronic dermatitis had MRSA detected only on perianal swab. Of 3 adult household contacts of the index case and 2 adult and 1 child contacts of the classroom contact, only the 7-year-old sibling of the classroom contact was positive for MRSA. By pulse-field gel electrophoresis, these isolates were identical and not related to any of the common strains circulating in regional health care institutions. Of 40 children with S. aureus (24.4%), 33 had cultures at 3 sites, of which the throat was more sensitive (22 [67%]) than the nostrils (15 [46%]) or perianal sites (8 [24%]). There was a tendency for higher carriage of S. aureus in children with certain risk factors, including personal hospitalization (prevalence ratio, 2.9; 95% confidence interval, 0.6-12.1), family member hospitalization (prevalence ratio, 2.0; 95% confidence interval, 0.6-6.6), and visiting the hospital emergency department (prevalence ratio, 3.2; 95% confidence interval, 0.7-14.5), all in the previous 6 months.
To our knowledge, this is one of the first recognized cases of MRSA disease and apparent transmission in a child care center. Throat and perianal site screenings have a higher sensitivity in identifying children colonized with S. aureus than nasal culturing. Infection with MRSA should be suspected in disease unresponsive to standard antibiotic therapy.
在一名此前健康的2岁半儿童保育中心参与者被诊断为社区获得性耐甲氧西林金黄色葡萄球菌（MRSA）疾病后，研究该儿童保育中心耐甲氧西林金黄色葡萄球菌和甲氧西林敏感金黄色葡萄球菌定植的患病率，并确定金黄色葡萄球菌的最佳检测部位。
现患率调查和问卷调查。
安大略省多伦多市的一家儿童保育中心。
向家长提供一般信息。同意参与的家长完成一份问卷，并允许在其孩子的咽喉、鼻腔和肛周部位中的一个或多个部位进行筛查。对MRSA培养呈阳性的儿童家庭提供筛查和抑制性治疗。从儿童保育中心工作人员处获取鼻腔和肛周拭子并进行筛查。
201名儿童中，164名（81.6%）完成了问卷并在一个或多个部位接受了筛查；38名工作人员（100%）完成了问卷并接受了筛查。一名患有慢性皮炎的26个月大的班级接触者仅在肛周拭子上检测出MRSA。在该首例病例的3名成年家庭接触者以及该班级接触者的2名成人和1名儿童接触者中，只有该班级接触者7岁的兄弟姐妹MRSA呈阳性。通过脉冲场凝胶电泳，这些分离株相同，且与地区医疗机构中传播的任何常见菌株均无关联。在40名金黄色葡萄球菌携带者儿童（24.4%）中，33名在3个部位进行了培养，其中咽喉部位比鼻孔（15名[46%]）或肛周部位（8名[24%]）更敏感（22名[67%]）。在有某些风险因素的儿童中，包括个人住院（患病率比值，2.9；95%置信区间，0.6 - 12.1）、家庭成员住院（患病率比值，2.0；95%置信区间，0.6 - 6.6）以及在过去6个月内去过医院急诊科（患病率比值，3.2；95%置信区间，0.7 - 14.5），金黄色葡萄球菌携带率有升高趋势。
据我们所知，这是儿童保育中心首次确认的MRSA疾病及明显传播病例之一。咽喉和肛周部位筛查在识别金黄色葡萄球菌定植儿童方面比鼻腔培养具有更高的敏感性。对于对标准抗生素治疗无反应的疾病，应怀疑MRSA感染。
