Dietrich Dinusha W, Auld Dianne B, Mermel Leonard A
Division of Pediatric Infectious Diseases, Department of Pediatrics, Brown Medical School and Rhode Island Hospital, Providence, Rhode Island, USA.
Pediatrics. 2004 Apr;113(4):e347-52. doi: 10.1542/peds.113.4.e347.
This study was performed to understand the epidemiology of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in southern New England children.
A retrospective review was conducted of the medical records of children 0 to 18 years old with MRSA isolated by the Rhode Island Hospital microbiology laboratory (Providence, RI) between 1997 and 2001. A case was classified as either health care-associated MRSA (HCA-MRSA) or CA-MRSA based on time of culture and other strict criteria. The spectrum of illness of the HCA-MRSA and CA-MRSA cases was compared, as were the antibiotic-susceptibility patterns of their isolates. Risk factors for CA-MRSA acquisition were identified, and molecular subtyping of selected isolates was performed.
Between 1997 and 2001, S aureus was isolated from 1063 children. Of these children, 57 had MRSA. During this period, both the absolute number of MRSA cases and the proportion of S aureus cases due to MRSA rose more than threefold due to increases in both CA-MRSA and HCA-MRSA infections. Of the 57 MRSA cases, 23 (40%) were CA-MRSA. CA-MRSA patients were more likely to have skin/soft-tissue infections than HCA-MRSA patients (83% vs 38%). Risk factors for acquisition of MRSA including intrafamilial spread, frequent antibiotic exposure, and child-care attendance were identified in 8 of the 23 (35%) CA-MRSA patients. CA-MRSA isolates were more likely to be susceptible to non-beta-lactam antibiotics than HCA-MRSA isolates. All isolates were vancomycin susceptible.
MRSA accounts for an increasing proportion of all pediatric S aureus infections in southern New England. A significant percentage of these cases are due to CA-MRSA. Pediatricians should have heightened suspicion for CA-MRSA in children with presumed S aureus infections, especially if they have skin/soft-tissue infections or risk factors for MRSA acquisition.
本研究旨在了解新英格兰南部儿童社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）感染的流行病学情况。
对罗德岛医院微生物实验室（罗德岛普罗维登斯）在1997年至2001年间分离出耐甲氧西林金黄色葡萄球菌的0至18岁儿童的病历进行回顾性研究。根据培养时间和其他严格标准，将病例分为医疗保健相关耐甲氧西林金黄色葡萄球菌（HCA-MRSA）或CA-MRSA。比较了HCA-MRSA和CA-MRSA病例的疾病谱以及分离株的抗生素敏感性模式。确定了CA-MRSA感染的危险因素，并对选定的分离株进行了分子亚型分析。
1997年至2001年间，从1063名儿童中分离出金黄色葡萄球菌。其中，57名儿童感染了耐甲氧西林金黄色葡萄球菌。在此期间，由于CA-MRSA和HCA-MRSA感染的增加，耐甲氧西林金黄色葡萄球菌病例的绝对数量和金黄色葡萄球菌病例中耐甲氧西林金黄色葡萄球菌所占的比例均增加了三倍多。在57例耐甲氧西林金黄色葡萄球菌病例中，23例（40%）为CA-MRSA。与HCA-MRSA患者相比，CA-MRSA患者更易发生皮肤/软组织感染（83%对38%）。在23例（35%）CA-MRSA患者中，有8例确定了感染耐甲氧西林金黄色葡萄球菌的危险因素，包括家庭内传播、频繁接触抗生素和入托。与HCA-MRSA分离株相比，CA-MRSA分离株更易对非β-内酰胺类抗生素敏感。所有分离株对万古霉素均敏感。
在新英格兰南部，耐甲氧西林金黄色葡萄球菌在所有儿童金黄色葡萄球菌感染中所占比例不断增加。这些病例中有很大一部分是由CA-MRSA引起的。对于疑似金黄色葡萄球菌感染的儿童，尤其是有皮肤/软组织感染或感染耐甲氧西林金黄色葡萄球菌危险因素的儿童，儿科医生应提高对CA-MRSA的怀疑。
