title: Community-associated methicillin-resistant Staphylococcus aureus strains in pediatric intensive care unit.
abstract: Virulent community-associated methicillin-resistant Staphylococcus-aureus (CA-MRSA) strains have spread rapidly in the United States. To characterize the degree to which CA-MRSA strains are imported into and transmitted in pediatric intensive care units (PICU), we performed a retrospective study of children admitted to The Johns Hopkins Hospital PICU, March 1, 2007-May 31, 2008. We found that 72 (6%) of 1,674 PICU patients were colonized with MRSA. MRSA-colonized patients were more likely to be younger (median age 3 years vs. 5 years; p = 0.02) and African American (p<0.001) and to have been hospitalized within 12 months (p<0.001) than were noncolonized patients. MRSA isolates from 66 (92%) colonized patients were fingerprinted; 40 (61%) were genotypically CA-MRSA strains. CA-MRSA strains were isolated from 50% of patients who became colonized with MRSA and caused the only hospital-acquired MRSA catheter-associated bloodstream infection in the cohort. Epidemic CA-MRSA strains are becoming endemic to PICUs, can be transmitted to hospitalized children, and can cause invasive hospital-acquired infections. Further appraisal of MRSA control is needed.
authors.affiliation: Department of Pediatric Infectious Diseases, The Johns Hopkins University School of Medicine, 200 N Wolfe St, Rubenstein 3141, Baltimore, MD 21287, USA. amilsto1@jhmi.edu
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Milstone
authors.forename: Karen C
authors.initials: KC
authors.lastname: Carroll
authors.forename: Tracy
authors.initials: T
authors.lastname: Ross
authors.forename: K Alexander
authors.initials: KA
authors.lastname: Shangraw
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D015142:Baltimore / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D016172:DNA Fingerprinting; D005260:Female; D005838:Genotype; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification; D016017:Odds Ratio; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology