Epidemiology of Methicillin-Resistant <i>Staphylococcus aureus</i> in a University Medical Center Day Care Facility

Hewlett, Angela; Falk, Pamela S.; Hughes, Katrina; Mayhall, C. Glen

doi:10.1086/605721

Cited by 21 publications

(16 citation statements)

References 13 publications

(4 reference statements)

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“…Importantly, our study which used molecular typing did not reveal evidence of person-to-person transmission of MRSA strains within classrooms. This is in contrast to the transmission observed by Hewlett et al in a single university-based facility (15). The molecular analysis of the colonizing MRSA strains revealed that six isolates were both PVL positive and SCCmec type IV, which is the classic molecular definition of CA-MRSA.…”

Section: Discussioncontrasting

confidence: 74%

“…Only limited information is available regarding the prevalence of colonization of healthy children attending CCCs in the United States. Single child care center prevalence studies have reported frequencies of MRSA colonization in children of 1.2% (2 of 164) (36) and 6.7% (7 of 104) (15). These results are similar to the 2.5% (3 of 122) (16) and 1.7% (5 of 291) (5) frequencies of MRSA colonization found in healthy children attending outpatient pediatric clinics in Chicago and to the 0.9% prevalence in children in Boston communities (24).…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and Risk Factor Analysis for Methicillin-Resistant Staphylococcus aureus Nasal Colonization in Children Attending Child Care Centers

et al. 2011

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Children attending child care centers (CCCs) are at increased risk for infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA). Nasal colonization often precedes infection, and MRSA colonization has been associated with increased infection risk. Community-associated MRSA (CA-MRSA) has caused increased MRSA infections in the general population, including children. Little is known about the frequency of MRSA nasal colonization in young children, particularly in those attending CCCs where disease transmission is common. We sampled the nares of 1,163 children in 200 classrooms from 24 CCCs in North Carolina and Virginia to assess S. aureus colonization. MRSA strains were molecularly analyzed for staphylococcal cassette chromosome mec (SCCmec) type, Panton-Valentine leukocidin status, and multilocus sequence type. A case-control study was performed to identify risk factors for MRSA colonization. We found that 18.1% children were colonized with S. aureus and 1.3% with MRSA. Molecular analysis of the MRSA strains identified 47% as CA-MRSA and 53% as health care-associated MRSA (HA-MRSA). Although two centers had multiple children colonized with MRSA, genotyping indicated that no transmission had occurred within classrooms. The case-control study did not detect statistically significant risk factors for MRSA colonization. However, MRSA-colonized children were more likely to be nonwhite and to have increased exposure to antibiotics and skin infections in the home. Both CA-MRSA and HA-MRSA strains were found colonizing the nares of children attending CCCs. The low frequency of colonization observed highlights the need for a large multicenter study to determine risk factors for MRSA colonization and subsequent infection in this highly susceptible population.

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Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Prevalence and Risk Factor Analysis for Methicillin-Resistant Staphylococcus aureus Nasal Colonization in Children Attending Child Care Centers

et al. 2011

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“…23,24 Further, patients with diabetes and inhaled corticosteroid exposure are immunosuppressed and at increased risk for colonization with MRSA. 25,26 Likewise, bronchiolar colonization and corticosteroid exposures are known risk factors for pneumonia due to Pseudomonas aeruginosa. 27 Many studies have identified prior antibiotic use as a risk factor for infections caused by MRSA and Pseudomonas aeruginosa.…”

Section: Discussionmentioning

confidence: 99%

Predicting antibiotic resistance to community‐acquired pneumonia antibiotics in culture‐positive patients with healthcare‐associated pneumonia

Madaras‐Kelly

Remington

Fan

et al. 2011

Journal of Hospital Medicine

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OBJECTIVE To develop and validate a model to predict resistance to community-acquired pneumonia antibiotics (CAP-resistance) among patients with healthcare-associated pneumonia (HCAP), and to compare the model’s predictive performance to a model including only guideline-defined criteria for HCAP. DESIGN Retrospective cohort study. SETTING Six Veterans Affairs Medical Centers in the northwestern United States. PATIENTS Culture-positive inpatients with HCAP. MEASUREMENTS Patients were identified based upon guideline-defined criteria for HCAP. Relevant cultures obtained within 48 hours of admission were assessed to determine bacteriology and antibiotic susceptibility. Medical records for the year preceding admission were assessed to develop predictive models of CAP-resistance with logistic regression. The predictive performance of cohort-developed and guideline-defined models was compared. RESULTS CAP-resistant organisms were identified in 118 of 375 culture-positive patients. Of guideline-defined criteria, CAP-resistance was associated (odds ratio (OR) [95% confidence interval (CI)]) with: admission from nursing home (2.6 [1.6–4.4]); recent antibiotic exposure (1.7 [1.0–2.8]); and prior hospitalization (1.6 [1.0–2.6]). In the cohort-developed model, CAP-resistance was associated with: admission from nursing home or recent nursing home discharge (2.3 [1.4–3.8]); positive methicillin-resistant Staphylococcus aureus (MRSA) history within 90 days of admission (6.4 [2.6–17.8]) or 91–365 days (2.3 [0.9–5.9]); cephalosporin exposure (1.8 [1.1–2.9]); recent infusion therapy (1.9 [1.0–3.5]); diabetes (1.7 [1.0–2.8]); and intensive care unit (ICU) admission (1.6 [1.0–2.6]). Area under the receiver operating characteristic curve (aROC [95% CI]) for the cohort-developed model (0.71 [0.65–0.77]) was significantly higher than for the guideline-defined model (0.63 [0.57–0.69]) (P = 0.01). CONCLUSIONS Select guideline-defined criteria predicted CAP-resistance. A cohort-developed model based primarily on prior MRSA history, nursing home residence, and specific antibiotic exposures provided improved prediction of CAP-resistant organisms in HCAP.

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“…Community prevalence rates of MSSA and MRSA colonization vary depending on the population studied and the geographic region. Creech et al 10 MRSA colonization vary across studies but include minority race/ethnicity, 9,14 low socioeconomic status, 9,14 family member working in health care, 10,14 asthma medication use, 16 and exposure to antibiotics. 16 To our knowledge, this is one of the first studies to evaluate MRSA and MSSA colonization in otitis-prone children.…”

Section: Commentmentioning

confidence: 99%

“…Creech et al 10 MRSA colonization vary across studies but include minority race/ethnicity, 9,14 low socioeconomic status, 9,14 family member working in health care, 10,14 asthma medication use, 16 and exposure to antibiotics. 16 To our knowledge, this is one of the first studies to evaluate MRSA and MSSA colonization in otitis-prone children. Although not specifically evaluating for S aureus, Jacobs et al 19 20 Antibiotic exposure may also be a risk factor for colonization, and our patients received a mean of 3.7 antibiotic courses in the year before enrollment.…”

Section: Commentmentioning

confidence: 99%

Methicillin-Resistant <emph type="ital">Staphylococcus aureus</emph> Colonization in Otitis-Prone Children

Marzouk

Nathawad²,

Hammerschlag³

et al. 2011

Arch Otolaryngol Head Neck Surg

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Epidemiology of Methicillin-Resistant Staphylococcus aureus in a University Medical Center Day Care Facility

Cited by 21 publications

References 13 publications

Prevalence and Risk Factor Analysis for Methicillin-Resistant Staphylococcus aureus Nasal Colonization in Children Attending Child Care Centers

Prevalence and Risk Factor Analysis for Methicillin-Resistant Staphylococcus aureus Nasal Colonization in Children Attending Child Care Centers

Predicting antibiotic resistance to community‐acquired pneumonia antibiotics in culture‐positive patients with healthcare‐associated pneumonia

Methicillin-Resistant <emph type="ital">Staphylococcus aureus</emph> Colonization in Otitis-Prone Children

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