title: Epidemiology of methicillin-resistant Staphylococcus aureus at a pediatric healthcare system, 1991-2003.
abstract: BACKGROUND
  The emergence and epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) at a Minneapolis pediatric healthcare facility was investigated.
  
  
  METHODS
  Children with MRSA infections from January 1991 to December 2003 were classified as community-associated (CA) or healthcare-associated (HA) using established criteria. Isolates were subtyped using pulsed-field gel electrophoresis and grouped into pulsed-field types (PFTs). Case and isolate characteristics were compared and temporal trends were assessed.
  
  
  RESULTS
  The first isolate classified as CA-MRSA in this healthcare facility was identified in 1991. CA-MRSA cases (n = 188) were more likely than HA-MRSA cases (n = 83) to have a skin or soft tissue infection (80% versus 59%) and to belong to a racial or ethnic minority group (82% versus 55%), whereas HA-MRSA cases were younger (median age, 3.4 years versus 4.9 years). The proportion of both CA- and HA-MRSA isolates susceptible to clindamycin and erythromycin declined during the study period. Isolates classified as CA-MRSA were more likely than HA-MRSA isolates to be USA300 (21% versus 11%, P = 0.05) and USA400 (62% versus 31%, P < 0.001) PFTs. Associations between case race/ethnicity and isolate PFT were observed independent of case classification.
  
  
  CONCLUSIONS
  CA-MRSA is well established in this pediatric population. Although no discernable changes in CA- or HA-MRSA case characteristics were documented during the study period, significant changes were observed in CA-MRSA isolate characteristics, indicating that this pathogen continues to evolve.
authors.affiliation: Minnesota Department of Health, St. Paul, Minnesota, USA. jessica.jungk@state.nm.us
authors.forename: Jessica
authors.initials: J
authors.lastname: Jungk
authors.forename: Kathryn
authors.initials: K
authors.lastname: Como-Sabetti
authors.forename: Patricia
authors.initials: P
authors.lastname: Stinchfield
authors.forename: Patricia
authors.initials: P
authors.lastname: Ackerman
authors.forename: Kathleen
authors.initials: K
authors.lastname: Harriman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016106:Methicillin Resistance; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects*