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In adults, colonization with methicillin-resistant Staphylococcus aureus (MRSA) is an independent predictor of subsequent MRSA infection. Recognition of this risk factor has led to implementation of control measures, such as placing colonized patients in isolation with contact precautions. However, such procedures in children may hinder family-centered care and have unintended, lasting consequences. Moreover, the risk for infection among MRSA-colonized children is unknown.
To explore this issue, investigators reviewed the records of children who were admitted to the pediatric intensive care unit (PICU) at a Baltimore hospital between March 2007 and March 2010 and were screened for colonization with MRSA. Colonization on admission was defined as having an admission nares surveillance culture (or any clinical culture obtained ≤3 days after admission) positive for MRSA.
Among 3140 children, 153 (4.9%) were found to be colonized or infected with MRSA on admission, including 131 with a positive nares culture and 22 with a positive culture ≤3 days after admission. Thirteen of these 153 children (8.5%) subsequently developed a MRSA infection, compared with 43 of the 2987 (1.4%) who were not colonized or infected at admission (relative risk, 5.9; 95% confidence interval, 3.4–10.1). Of these 56 infections, 46 (82%) occurred after hospital discharge.
An additional 15 children acquired MRSA colonization in the PICU. Seven such children subsequently developed a MRSA infection — six of them while still hospitalized.
Milstone AM et al. Methicillin-resistant Staphylococcus aureus colonization and risk of subsequent infection in critically ill children: Importance of preventing nosocomial methicillin-resistant Staphylococcus aureus transmission. Clin Infect Dis 2011 Nov 1; 53:853.
Comment
In severely ill children (as in adults), MRSA colonization or infection is associated with a considerable risk for subsequent MRSA infection, and this risk seems to be especially high in individuals who become colonized during hospitalization. Unfortunately, the researchers did not examine for methicillin-sensitive S. aureus colonization, which has also been found to be associated with increased risk for infection. As the authors note, future studies should address interventions to prevent nosocomial MRSA transmission to children, as well as measures to protect colonized children from subsequent infection.