Article Text

  1. D. Jackson,
  2. M. McLeod,
  3. H. Fujio,
  4. S. Moser,
  5. J. Schilleci,
  6. B. Vason,
  7. V. Acharya,
  8. M. Amaya
  1. University of Alabama at Birmingham, Birmingham, AL


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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