Objective To assess the incidence and pattern of community-acquired MRSA (CA-MRSA) infections among Alabama children during the 1999-2005 study period.
Methods MRSA infections were considered community acquired if patients had positive cultures within 72 hours of admission and no prior history of MRSA infection. A retrospective chart review was performed for patients with cultures positive for MRSA infections at the Children's Hospital of Alabama from 1999 through the first 5 months of 2004. Prospective interviews were done for 33 CA-MRSA hospitalized patients identified in 2005. Patients were assigned a risk classification for resistant infections. Low-risk patients had no risk factors. Intermediate-risk patients had a single risk factor, often the presence of myringotomy tubes. High-risk patients typically had hospitalizations or surgery within the preceding 12 months. CA-MRSA and hospital-acquired MRSA (HA-MRSA) isolates collected in 2005 were genetically tested via pulse field gel electrophoresis (PFGE) for comparison of their genotypes. HA-MRSA patients had a positive MRSA culture taken after 72 hours of admission or had a history of a previous MRSA infection.
Results 63% of CA-MRSA cases presented as skin infections, 21% as otorrhea, and 6% as invasive infections. Cases of CA-MRSA rose from 17 in 2000 to 96 in the first 5 months of 2004. From 1999-2003 31% of CA-MRSA cases were resistant to clindamycin. Of 33 cases of CA-MRSA studied prospectively in 2005, only 1 was resistant to clindamycin, confirmed by D-zone test. According to PFGE, CA-MRSA is a new strain genetically distinct from most HA-MRSA; however, some clinical HA-MRSA genetically matched CA-MRSA strains.
Conclusions The increased incidence and genetic distinction of CA-MRSA indicate that these infections deserve increased medical and public health intervention.
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