Epidemic of community-acquired methicillin-resistant Staphylococcus aureus infections: a 14-year study at Driscoll Children's Hospital.
BACKGROUND
Previously we reported the rapid emergence and exponential increase of community-acquired (CA) methicillin-resistant Staphylococcus aureus (MRSA) infections in South Texas children.


OBJECTIVE
To assess whether changes have occurred in the frequency, types, susceptibility, and treatment of CAMRSA infections at Driscoll Children's Hospital.


METHODS
Data from 1990 through 2001 were collected during 2 previous studies. Data from 2002 through 2003 were collected and compared with data from 1990 through 2001. All S aureus isolates were identified by a computer-assisted search of culture results, and the medical records were reviewed for all patients with MRSA infections.


RESULTS
A total of 1002 MRSA cases were identified from 1990 through 2003 of which 928 (93%) were community-acquired. The number of CAMRSA cases ranged from 0 to 9 per year from 1990 through 1999 and then increased exponentially from 36 in 2000 to 459 in 2003. The most common type of CAMRSA infection in children without (94%) and with (72%) risk factors was cellulitis and abscess. A higher percentage of children with risk factors had invasive CAMRSA infections (26% vs 3%; P<.001). From 2002 through 2003, there was a significant difference in clindamycin susceptibility between CAMRSA isolates from children without and with risk factors and nosocomial isolates (97% and 86% vs 62%; P<.005). A higher percentage of patients admitted for treatment of CAMRSA infections received an empirical intravenous antibiotic to which the organism was susceptible when comparing 2002-2003 with 1990-2000 (96% vs 15%; P<.001). During this 14-year study, all patients recovered, including those with life-threatening CAMRSA infections.


CONCLUSIONS
The rapid emergence of CAMRSA as a cause of noninvasive and invasive infections in children, which started occurring in the 1990s, has reached epidemic proportions.
Purcell
Kevin
K
Pediatric Research 4U, Healthcare Leaders 2B, 13501 Camino De Plata Court, Corpus Christi, TX 78418, USA. kevinpurcell@stx.rr.com
Fergie
Jaime
J
D002648:Child; D017714:Community-Acquired Infections / Q000453:epidemiology; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology*; D013781:Texas / Q000453:epidemiology