title: Community-acquired methicillin-resistant Staphylococcus aureus in southern New England children.
abstract: OBJECTIVE
  This study was performed to understand the epidemiology of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in southern New England children.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, Brown Medical School and Rhode Island Hospital, Providence, Rhode Island, USA.
authors.forename: Dinusha W
authors.initials: DW
authors.lastname: Dietrich
authors.forename: Dianne B
authors.initials: DB
authors.lastname: Auld
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Mermel
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016106:Methicillin Resistance; D009511:New England / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000209:etiology; D013211:Staphylococcus aureus / Q000302:isolation & purification