title: Clinical characteristics and epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in children with cystic fibrosis from a center with a high MRSA prevalence.
abstract: BACKGROUND
  We describe the clinical characteristics and epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in children with cystic fibrosis (CF) from the U.S. CF center with the highest MRSA prevalence.
  
  
  METHODS
  Medical records of children with CF were retrospectively reviewed from 1997-2009. MRSA clinical isolates from 2007-2009 were analyzed by polymerase chain reaction and pulsed field gel electrophoresis.
  
  
  RESULTS
  The prevalence of MRSA was 1% in 1997 and 49% in 2009. Fifty-five children (26%) had persistent MRSA infection. Sixty-eight percent of MRSA isolates were hospital-associated (HA) MRSA, of which 52% were pulsed-field type USA 100. Ninety-three percent of HA MRSA isolates were clindamycin resistant. Twelve children acquired MRSA before 1 year of age, 83% of whom were hospitalized prior to acquisition of MRSA. Ten of 11 sibling pairs carried indistinguishable MRSA strains. Children with persistent MRSA were hospitalized more often (P = .01), required inhaled medications more frequently (P = .01), and had higher rates of Pseudomonas aeruginosa coinfection (P < .001).
  
  
  CONCLUSIONS
  MRSA prevalence in children with CF is increasing, and most children are infected with HA MRSA. Exposure to health care facilities and gastrointestinal surgeries may facilitate early acquisition of MRSA. Siblings carry indistinguishable MRSA strains, indicating household transmission of MRSA. Children with persistent MRSA had worse pulmonary morbidity. Coinfection with MRSA and P aeruginosa is likely associated with further increased pulmonary morbidity.
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR. Electronic address: hariknada@uams.edu.
authors.forename: Nada S
authors.initials: NS
authors.lastname: Harik
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: Gulnur
authors.initials: G
authors.lastname: Com
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Tang
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: Maria
authors.initials: M
authors.lastname: Melguizo Castro
authors.affiliation: Molecular Epidemiology, Marshfield Labs, Marshfield, WI.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Stemper
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: John L
authors.initials: JL
authors.lastname: Carroll
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology / Q000382:microbiology; D003550:Cystic Fibrosis / Q000150:complications*; D004269:DNA, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D058889:Molecular Typing; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011552:Pseudomonas Infections / Q000453:epidemiology / Q000382:microbiology; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D014481:United States / Q000453:epidemiology
chemical_list: D004269:DNA, Bacterial
keywords: Children; Cystic fibrosis; Methicillin-resistant Staphylococcus aureus